2016, Número 1
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Rev Cubana Cardiol Cir Cardiovasc 2016; 22 (1)
Disfunción microvascular y síndrome X en la mujer postmenopáusica. Exámenes diagnósticos para detección de isquemia
Peix GA
Idioma: Español
Referencias bibliográficas: 37
Paginas: 4-12
Archivo PDF: 438.73 Kb.
RESUMEN
La enfermedad cardiovascular es la primera causa de mortalidad en adultos a nivel mundial y en la mujer postmenopáusica la incidencia aumenta. El diagnóstico del síndrome X cardíaco (angina con infradesnivel del segmento ST y coronarias epicárdicas sin lesiones significativas), más frecuente en la mujer, es generalmente de exclusión. Demostrar que el paciente tiene una isquemia requiere de un análisis más detallado que simplemente considerar el estado anatómico de sus coronarias mediante una angiografía. Se presentan los exámenes para detección de isquemia, con o sin imagen, como parte del diagnóstico del síndrome X, donde la disfunción microvascular constituye un mecanismo fisiopatológico importante. Se concluye que el síndrome X debe considerarse como una entidad cuyo pronóstico no es benigno, en la que deben tenerse en cuenta las técnicas de imagen que permiten una demostración de isquemia funcionalmente significativa que apoye el diagnóstico y que permita instaurar una conducta terapéutica adecuada.
REFERENCIAS (EN ESTE ARTÍCULO)
Institute for Health Metrics and Evaluation. The Global Burden of Diseases, Injuries and Risk Factors Study 2010 (GBD 2010). Generating Evidence, Guiding Policy Report.
Anuario Estadístico de Salud 2014. MINSAP. Disponible en: http: www.sld.cu/sitios/dne/
Ehendy A, Mahoney DW, Khandheria BK, Burger K, Pelikka PA. Prognostic significance of impairment of heart rate response to exercise: Impact of left ventricular function and myocardial ischemia. J Am Coll Cardiol 2003;42:823-30.
Radico F, Cicchitti V, Zimarino M, De Caterina R. Angina pectoris and myocardial ischemia in the absence of obstructive coronary artery disease: practical considerations for diagnostic tests. J Am Coll Cardiol Intv 2014;7:45363.
Jespersen L, Hvelplund A, Abildstrøm SZ, Pedersen F, Galatius S, Madsen JK, y cols. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J 2012;33:73444.
Sedlak T, Izadnegahdar M, Humphries KH, Merz NB. Sex-specific factors in microvascular angina. Can J Cardiol 2014;30:74755.
Agrawal S, Mehta PK, Merz NB. Cardiac Syndrome X Update 2014. Cardiol Clin 2014;32:46378.
Lin FY, Shaw LJ, Dunning AM, Labounty TM, Choi JH, Weinsaft JW, y cols. Mortality risk in symptomatic patients with nonobstructive coronary artery disease: a prospective 2-center study of 2,583 patients undergoing 64-detector row coronary computed tomographic angiography. J Am Coll Cardiol 2011;58:510-9.
Suzuki H. Different definition of microvascular angina. Eur J Clin Invest 2015;45: 13606.
Jones E, Eteiba W, Merz NB. Syndrome X and microvascular coronary dysfunction. Trends Cardiovasc Med 2012;22:1618.
Luo C, Long M, Hu X, Huang Z, Hu C, Gao X, y cols. Thermodilution-derived coronary microvascular resistance and flow reserve in patients with cardiac syndrome X. Circ Cardiovasc Interv 2014;7:43-8.
Recio-Mayoral A, Rimoldi OE, Camici PG, Kaski JC. Inflammation and microvascular dysfunction in cardiac syndrome X patients without conventional risk factors for coronary artery disease. JACC Cardiovasc Imaging 2013;6:6607.
Taqueti VR, Ridker PM. Inflammation, coronary flow reserve, and microvascular dysfunction. JACC Cardiovasc Imaging 2013;6:668-71.
Vaccarino V, Badimon L, Corti R, de Wit C, Dorobantu M, Hall A, y cols. Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors? Position paper from the working group on coronary pathophysiology and microcirculation of the European Society of Cardiology. Cardiovasc Res 2011;90:9-17.
Herrmann J, Kaski JC, Lerman A. Coronary microvascular dysfunction in the clinical setting: from mystery to reality. Eur Heart J 2012;33:277181.
Vavas E, Hong SE, Henry S, Rosen SE, Mieres JH. Imaging tests, provocative tests, including exercise testing in women with suspected coronary artery disease. Curr Cardiovasc Risk Rep 2012;6:46978.
Mieres JH, Shaw LJ, Arai A, Budoff MJ, Flamm SD, Hundley WG, y cols. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 2005;111:68296.
Rinkevich D, Belcik T, Gupta NC, Cannard E, Alkayed NJ, Sanjiv K. Coronary autoregulation is abnormal in syndrome X: Insights using myocardial contrast echocardiography. J Am Soc Echocardiogr 2013;26:290-6.
Schindler TH, Nitzsche E, Magosaki N, Brink I, Mix M, Olschewski M, y cols. Regional myocardial perfusion defects during exercise, as assessed by three dimensional integration of morphology and function, in relation to abnormal endothelium dependent vasoreactivity of the coronary microcirculation. Heart 2003; 89:51726.
Peix A, González A, García EJ, Valiente J, Cabrera LO, Sixto S, y cols. Left ventricular dysfunction secondary to ischemia in women with angina and normal coronary angiograms. J Womens Health 2009;18:155-61.
Peix A, Trápaga A, Asen L, Ponce F, Infante O, Valiente J, y cols. Mental stress-induced myocardial ischemia in women with angina and normal coronary angiograms. J Nucl Cardiol 2006;13:507-13.
Peix A, García EJ, Valiente J, Cabrera LO, Filgueiras CE, Cabalé B, y cols. Angina with normal epicardial coronary arteries: does gender imply any difference in ischemia detection? The Internet Journal of Cardiology 2007. Vol 5, Number 1. Disponible en: http://www.ispub.com/ostia/index
Szot W, Zajac J, Kostkiewicz M, Kolarzyk E. Dietary patterns seem to influence the development of perfusion changes in cardiac syndrome X patients. Adv Clin Exp Med 2015; 24:45362.
Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Buechel RR, Küest SM, y cols. Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography. Eur Heart J 2011;32:146571.
Murthy VL, Naya M, Taqueti VR, Foster CR, Gaber M, Hainer J, y cols. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation 2014;129:251827.
Kuruvilla S, Kramer CM. Coronary microvascular dysfunction in women: an overview of diagnostic strategies. Expert Rev Cardiovasc Ther 2013;11:151525.
Thomson LE, Wei J, Agarwal M, Haft-Baradaran A, Shufelt C, Mehta PK, y cols. Cardiac magnetic resonance myocardial perfusion reserve index is reduced in women with coronary microvascular dysfunction. A National Heart, Lung, and Blood Institute-Sponsored Study from the Women’s Ischemia Syndrome Evaluation. Circ Cardiovasc Imaging 2015;8:e002481. DOI: 10.1161/CIRCIMAGING.114.002481.
Dorbala S, Hachamovitch R, Curillova Z, Thomas D, Vangala D, Kwong RY, y cols. Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging 2009;2:84654.
Murthy VL, Naya M, Foster CR, Gaber M, Hainer J, Klein J, y cols. Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes mellitus. Circulation 2012;126:185868.
Pepine CJ, Ferdinand KC, Shaw LJ, Light-McGroary KA, Shah RU, Gulati M, y cols. Emergence of nonobstructive coronary artery disease. A woman’s problem and need for change in definition on angiography. J Am Coll Cardiol 2015;66:191833.
Lanza GA, Buffon A, Sestito A, Natale L, Sgueglia GA, Galiuto L, y cols. Relation between stress-induced myocardial perfusion defects on cardiovascular magnetic resonance and coronary microvascular dysfunction in patients with cardiac syndrome X. J Am Coll Cardiol 2008;51:466-72.
Celermajer D, Sorensen K, Gooch V. Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992;340:1111-5.
Sucato V, Evola S, Quagliana A, Novo G, Andolina G, Assennato P, y cols. Comparison of coronary artery flow impairment in diabetic and hypertensive patients with stable microvascular angina. Eur Rev Med Pharmacol Sci 2014;18:3687-9.
Huxley RR, Peters SA, Mishra GD, Woodward M. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2015;3:198206.
Pellegrino T, Storto G, Perrone Filardi P. Relationship between brachial artery flow-mediated dilation and coronary flow reserve in patients with peripheral artery disease. J Nucl Med 2005; 46:1997-2002.
Pries AR, Badimon L, Bugiardini R, Camici PG, Dorobantu M, Duncker DJ, y cols. Coronary vascular regulation, remodelling, and collateralization: mechanisms and clinical implications on behalf of the working group on coronary pathophysiology and microcirculation. Eur Heart J 2015;36:3134-46.
Ong P, Athanasiadis A, Borgulya G, Vokshi I, Bastiaenen R, Kubik S, y cols. Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries. Circulation 2014;129:1723-30.