PREVALENCIA DE LA DISFUNCION SISTOLICA TRATABLE EN PACIENTES CON ENFERMEDADES VASCULARES




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PREVALENCIA DE LA DISFUNCION SISTOLICA TRATABLE EN PACIENTES CON ENFERMEDADES VASCULARES

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La disfunción sistólica del ventrículo izquierdo es más común en los pacientes con enfermedades vasculares. Casi dos tercios son asintomáticos. Nuestros hallazgos sugieren que esta incidencia justifica una pesquisa de rutina.
kelly9.jpg Autor:
Robert V Kelly
Columnista Experto de SIIC

Institución:
Division of Cardiology University of North Carolina at Chapel Hill North Carolina, USA


Artículos publicados por Robert V Kelly
Recepción del artículo
18 de Junio, 2004
Aprobación
15 de Septiembre, 2004
Primera edición
24 de Febrero, 2005
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La disfunción sistólica del ventrículo izquierdo (DSVI) es tan frecuente como tratable. Entonces, deberíamos identificar estos pacientes. Una manera rentable de detectar los enfermos con DSVI que habitualmente se pasarían por alto, podría ser la pesquisa de los pacientes que se presentan en el hospital por un primer episodio vascular no cardíaco, por ejemplo, su primer accidente cerebro vascular (ACV), accidente isquémico transitorio (AIT) o un nuevo episodio de enfermedad vascular periférica (EVP). Pacientes pertenecientes a una serie consecutiva de 255 enfermos con ACV, AIT y EVP, de entre 45 y 86 años, fueron identificados en su primer ingreso en el hospital por patología vascular no cardíaca. Además, se convocaron 202 controles equiparables por edad y sexo provenientes del servicio de medicina familiar. A cada paciente se le realizó historia clínica, examen físico, ecocardiografía y a 12 se les efectuó ECG. La DSVI fue definida como una fracción de eyección del ventrículo izquierdo (FEVI) igual o menor al 40%. Se encontró disfunción del ventrículo izquierdo (VI) en 28% de los pacientes vasculares, en comparación con 5.5% de los controles equiparados por edad y sexo. Casi dos tercios de los pacientes con DSVI eran asintomáticos. La DSVI es más común en los pacientes con antecedentes de ACV, AIT y EVP que en la población general. Nuestros hallazgos sugieren que la incidencia de DSVI en este tipo de pacientes justifica efectuar una pesquisa de rutina. Futuros estudios deben considerar si la pesquisa de DSVI en estos pacientes podrá reducir el reconocido alto índice de fallecimiento por causas cardíacas.

Palabras clave
Disfunción sistólica del ventrículo izquierdo, enfermedad vascular, ecocardigrafía, accidente cerebrovascular, pesquisa


Artículo completo

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Abstract
Left ventricular systolic dysfunction (LVSD) is both common and treatable. So we ought to be identifying these patients. A cost effective way to detect LVSD patients who would normally be missed might be to screen patients who present to hospital with their first noncardiac vascular event i.e. their first stroke, their first transient ischemic attack (TIA) or new onset of peripheral vascular disease (PVD). A consecutive series of 255 stroke, TIA and PVD patients aged between 45 and 86 years were identified at their first noncardiac vascular presentation to hospital. Age and gender matched controls (202) were recruited from family practice. Each patient underwent a history, physical examination, echocardiography and a 12 lead ECG. LVSD was defined as LVEF ≤ 40%. LV dysfunction was found in 28% of vascular patients compared with 5.5% of age and gender-matched controls. Almost two thirds of LVSD patients were asymptomatic. LVSD is more common in stroke, TIA and PVD patients than it is in the general population. Our findings would suggest that there is enough LVSD in such patients to warrant routine screening. Future studies should consider whether screening for LVSD in these patients would reduce their known high rate of cardiac death.

Key words
LV systolic dysfunction, vascular disease, echocardiography, stroke, screening


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Especialidades
Principal: Cardiología
Relacionadas: Diagnóstico por Laboratorio, Medicina Interna



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Kelly, Robert V
Patrocinio y reconocimiento:
Agradecimientos. Este estudio fue respaldado por la Scottish Health Office, Reino Unido.
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