LA EVOLUCION DEL VALOR PRONOSTICO DE LA PRUEBA DE ESFUERZO CARDIOPULMONAR EN LOS PACIENTES CON INSUFICIENCIA CARDIACA





LA EVOLUCION DEL VALOR PRONOSTICO DE LA PRUEBA DE ESFUERZO CARDIOPULMONAR EN LOS PACIENTES CON INSUFICIENCIA CARDIACA

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Entre los investigadores que evalúan la prueba de esfuerzo cardiopulmonar en pacientes con insuficiencia cardíaca, se reconoce que el abordaje multivariado debe aplicarse para una óptima definición del pronóstico. Asimismo, los clínicos han comenzado a aplicar este enfoque. En esta revisión, se describe la evolución del uso de esta prueba en los sujetos con insuficiencia cardíaca en los últimos 20 años.
arena9_101012.jpg Autor:
Ross Arena
Columnista Experto de SIIC

Institución:
University of New Mexico


Artículos publicados por Ross Arena
Coautores
Jonathan Myers* Marco Guazzi** 
VA Palo Alto Healthcare System, Palo Alto, EE.UU.*
University of Milano, Milán, Italia**
Recepción del artículo
18 de Mayo, 2012
Aprobación
19 de Julio, 2012
Primera edición
22 de Octubre, 2012
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Hace 20 años, en el importante estudio de Donna Mancini, se demostró el valor pronóstico de la prueba de esfuerzo cardiopulmonar (PECP) en pacientes con insuficiencia cardíaca. En ese ensayo se evaluó la utilidad del consumo máximo de oxígeno para definir el riesgo de mortalidad en una cohorte de 114 enfermos con insuficiencia cardíaca. La repercusión de los resultados iniciales influyó sobre la práctica clínica durante más de una década, durante la cual el consumo máximo de oxígeno era en general la única variable de la PECP que se consideraba para la estratificación del riesgo. A lo largo de los últimos 20 años, se ha demostrado en gran cantidad de investigaciones la importancia de otras variables de la PECP en el pronóstico. Los restantes parámetros relevantes de la PECP en la insuficiencia cardíaca incluyen los índices de eficacia ventilatoria (pendiente VM/CO2, presión parcial de dióxido de carbono en el aire espirado, ventilación oscilante en el ejercicio), frecuencia cardíaca, respuesta electrocardiográfica y de otros parámetros hemodinámicos, y la sintomatología. Entre los investigadores que evalúan la PECP en pacientes con insuficiencia cardíaca, se reconoce que el abordaje multivariado debe aplicarse para una óptima definición del pronóstico. Los clínicos responsables del tratamiento de los pacientes con insuficiencia cardíaca han comenzado a aplicar este enfoque. En esta revisión, se describe la evolución del uso de la PECP en los sujetos con insuficiencia cardíaca en estos 20 años.

Palabras clave
prueba de esfuerzo, eventos adversos, modelo multivariado


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Abstract
Twenty years ago, the seminal study led by Donna Mancini demonstrating the prognostic value of cardiopulmonary exercise testing (CPX) in heart failure (HF) was published. This study assessed the ability of peak oxygen consumption (VO2) to reflect mortality risk in a cohort consisting of 114 patients with HF. The impact of these initial findings influenced clinical practice patterns for more than a decade in that peak VO2 was commonly the only CPX variable considered for risk stratification. Over the last 20 years, a large body of data demonstrating the prognostic importance of other CPX variables has come to fruition. The additional CPX measures highly relevant to the HF population include indices of ventilatory efficiency (i.e. the VE/VCO2 slope, the partial pressure of end-tidal carbon dioxide and exercise oscillatory ventilation), heart rate, electrocardiographic and other hemodynamic responses, and symptomatology. In the scientific community committed to the study of CPX in HF, it is currently well-recognized that a multivariate approach should be applied for optimal prognostic assessment. The clinical community responsible for the management of the HF population has begun to embrace this approach. This review describes the 20 year evolution of CPX in the HF population.

Key words
exercise testing, adverse events, multivariate model


Full text
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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología
Relacionadas: Atención Primaria, Geriatría, Medicina Familiar, Medicina Interna, Trasplantes



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Enviar correspondencia a:
Ross Arena, University of New Mexico School of Medicine, NM 87131-0, Alburquerque, EE.UU.
Bibliografía del artículo
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