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Cardiopatía en la esclerosis sistémica: mecanismos, manifestaciones y manejo
Chin Yit Soo1, Nicholas Jex1, Lesley-Anne Bissell2
1Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, United Kingdom.
Rheumatology (Oxford, England)
|February 4, 2026
Resumen
La esclerosis sistémica puede causar cardiopatía primaria (SSc-PHI) a través de vías vasculares e inmunitarias, lo que conduce a fibrosis miocárdica. La detección temprana mediante cribado e imagen avanzada como la CMR es crucial para una mejor estratificación del riesgo y los resultados del paciente.
Área de la Ciencia:
- Cardiología
- Reumatología
- Inmunología
Sus antecedentes:
- La enfermedad cardiovascular es una causa importante de mortalidad en la esclerosis sistémica (SSc).
- La cardiopatía primaria en la SSc (SSc-PHI) afecta significativamente los resultados de los pacientes.
- Comprender la fisiopatología de la SSc-PHI es vital para un manejo eficaz.
Objetivo del estudio:
- Revisar la fisiopatología de la SSc-PHI.
- Esbozar las manifestaciones clínicas y las estrategias de manejo.
- Analizar las necesidades insatisfechas y las posibles soluciones para la SSc-PHI.
Principales métodos:
- Revisión de la literatura centrada en los mecanismos, características clínicas y diagnósticos de la SSc-PHI.
- Análisis de las vías vasculares e inmunomediadas.
- Evaluación de las herramientas de cribado, incluidos biomarcadores e imagen (ecocardiografía, RMC).
Principales resultados:
- La SSc-PHI implica vías vasculares e inmunitarias, la inflamasa NLRP3 y citoquinas profibróticas, causando fibrosis miocárdica.
- Las manifestaciones clínicas requieren cribado regular con biomarcadores y ecocardiografía.
- La resonancia magnética cardíaca (RMC) detecta enfermedad subclínica con valor pronóstico.
Conclusiones:
- La identificación temprana de la SSc-PHI subclínica es una necesidad insatisfecha crítica para mejorar la estratificación del riesgo.
- Es esencial una atención interdisciplinaria mejorada a través de la colaboración cardiorrheumatológica.
- El desarrollo de estrategias diagnósticas y terapéuticas novedosas es imperativo para el manejo de la SSc-PHI.
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