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Valor pronóstico del acoplamiento ventricular-pulmonar derecho en la regurgitación mitral primaria

Sara Moura-Ferreira^1,2, Nicola Riccardo Pugliese³, Mauricio Milani^1,4,5

¹Department of Cardiology and Jessa & Science, Jessa Hospital, Hasselt, Belgium (S.M.-F., M. Milani, M.F., Y.B., R.J., G.C., L.H., J.V.).

|November 3, 2025

Resumen

El ejercicio de acoplamiento arterial ventricular-pulmonar derecho utilizando la excursión sistólica del plano anular tricúspide (TAPSE) y la relación de presión sistólica de la arteria pulmonar (sPAP) ofrece valiosos conocimientos pronósticos para pacientes con regurgitación mitral primaria. Esta medida, especialmente durante el ejercicio, ayuda a la estratificación del riesgo y a las decisiones de gestión.

Área de la Ciencia:

Cardiología
Fisiología cardiovascular
La ecocardiografía

Sus antecedentes:

La gestión de la regurgitación mitral primaria significativa (MR) presenta desafíos clínicos.
El acoplamiento ventricular-pulmonar derecho (RV-PA), evaluado mediante TAPSE/sPAP, indica la adaptabilidad de RV a la carga posterior.
La evaluación del valor pronóstico del reposo y el ejercicio TAPSE/sPAP en la RM primaria es crucial.

Objetivo del estudio:

Evaluar la importancia pronóstica del reposo y el ejercicio TAPSE/sPAP en pacientes con MR primaria.
Para determinar si el acoplamiento RV-PA del ejercicio proporciona información prognóstica incremental.
Establecer un método factible y preciso para la estratificación del riesgo en la RM primaria.

Principales métodos:

Un estudio internacional de cohorte multicéntrico en el que participaron 357 pacientes con MR primario de moderado a severo.
Prueba de ejercicio cardiopulmonar con ecocardiografía de ejercicio.
Medida de TAPSE/sPAP en reposo, ejercicio intermedio y pico; punto final primario: compuesto de muerte cardiovascular, hospitalización y nueva fibrilación auricular.

Principales resultados:

La exTAPSE/sPAP intermedia demostró una alta viabilidad (98%) y una precisión de pronóstico comparable a la exTAPSE/sPAP pico.
La reducción de la TAPSE/sPAP en reposo y la exTAPSE/sPAP intermedia se asociaron con una menor supervivencia libre de eventos.
El exTAPSE/sPAP intermedio y el pico de VO2 fueron predictores independientes de resultados adversos, ofreciendo valor más allá de los factores tradicionales.

Conclusiones:

El acoplamiento del ejercicio RV-PA, en particular el exTAPSE/sPAP intermedio, es un marcador pronóstico robusto y factible en la RM primaria.
Esta medida proporciona información de pronóstico más allá de las variables de reposo y la aptitud cardiorrespiratoria.
El ejercicio TAPSE/sPAP puede refinar la estratificación del riesgo y guiar las estrategias de manejo para los pacientes con RM primaria.

Palabras clave:

ecocardiografía Prueba de ejercicio Insuficiencia de la válvula mitral el pronóstico

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