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2006, Número 1

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Gac Med Mex 2006; 142 (1)


Implicaciones clínicas y pronósticas del estudio circadiano de la modulación simpático-vagal de la variabilidad de la frecuencia cardiaca en pacientes con hipertensión arterial pulmonar grave

Rosas-Peralta M, Sandoval-Zárate J, Attie F, Pulido T, Santos E, Granados MZ, Miranda T, Escobar V

Idioma: Español
Referencias bibliográficas: 44
Paginas: 19-28
Archivo PDF: 293.09 Kb.


RESUMEN

Introducción: La reducción en la variabilidad de la frecuencia cardiaca ha sido identificada como factor de riesgo en enfermedad cardiovascular, pero su descripción en hipertensión arterial pulmonar severa se desconoce.
Material y métodos: Se estudiaron pacientes con hipertensión arterial pulmonar grave, 32 con hipertensión pulmonar primaria, 34 con hipertensión pulmonar secundaria a cardiopatía congénita (Eisenmenger) y 44 sujetos control sin evidencia de enfermedad. La evaluación del registro ambulatorio de la frecuencia cardiaca se realizó por métodos convencionales. El análisis espectral y la relación a baja y alta frecuencia se realizó utilizando el método de Fourier. Comparaciones entre día y noche se realizó entre los grupos. Después de conocer el perfil circadiano, 15 pacientes con hipertensión pulmonar fueron seleccionados para recibir tratamiento al azar con Treprostinil (Prostaglandina) o placebo por vía subcutánea. Posteriormente (3 meses) se analizaron nuevamente los parámetros de variabilidad de frecuencia cardiaca y de hemodinámica para conocer el impacto de dicha terapéutica.
Resultados: Se detectó un estado franco de hipertonía simpática en el grupo de hipertensión pulmonar, sobre todo en los pacientes con hipertensión pulmonar primaria. El efecto de Treprostinil fue claramente asociado con disminución del tono simpático y un aumento de la capacidad física.
Conclusiones: Los pacientes con hipertensión arterial pulmonar, cursan con equilibrio simpático-vagal alterado sobre todo durante el día. Hay pérdida del ritmo circadiano. Dichos trastornos pueden ser reversibles con la aplicación de treprostinil. El equilibrio simpático-vagal de la frecuencia cardiaca es un instrumento no invasivo que permite estratificar mejor al paciente con hipertensión arterial pulmonar grave.


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