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VALORACION ECOCARDIOGRAFICA DE LA DISFUNCION DIASTOLICA Y LA INSUFICIENCIA CARDIACA DIASTOLICA

VALORACION ECOCARDIOGRAFICA DE LA DISFUNCION DIASTOLICA Y LA INSUFICIENCIA CARDIACA DIASTOLICA

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El tratamiento de la disfunción diastólica del ventrículo izquierdo y la insuficiencia cardíaca diastólica no está bien establecido pero los inhibidores de la enzima convertidora de angiotensina, los antagonistas de la aldosterona y los betabloqueantes muestran un potencial beneficio sobre las propiedades diastólicas del miocardio.
galderisi9.jpg Autor:
Maurizio Galderisi
Columnista Experto de SIIC

Institución:
Federico II University Hospital


Artículos publicados por Maurizio Galderisi
Coautores
Rubén Sánchez* Marisa Durú** 
MD, Residente de Ecocardiografía, Universidad Nacional Autónoma de México y del Consejo Mexicano de Cardiología, México, México*
MD, Faculdade de Ciências Médicas da Universidad Estadual de Campinas, San Pablo, Brasil**
Recepción del artículo
27 de Julio, 2006
Aprobación
3 de Agosto, 2006
Primera edición
27 de Noviembre, 2006
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La disfunción diastólica (DD) del ventrículo izquierdo (VI) y la insuficiencia cardíaca diastólica (IC), que es la DD sintomática, son dos alteraciones de las propiedades diastólicas del miocardio. Estas alteraciones involucran tanto la relajación como el llenado y la distensibilidad. La hipertensión arterial asociada al VI con remodelación concéntrica es el principal determinante de la DD pero existen otras patologías cardíacas, como la isquemia miocárdica, y las extracardíacas que involucran el corazón son otras posibles causas. En la mayoría de los estudios la IC diastólica aislada es igual a la IC con función sistólica preservada (= fracción de expulsión normal), pero la verdadera definición de esta condición necesita de la estimación cuantitativa de las propiedades diastólicas del VI. Según la Sociedad Europea de Cardiología y estudios subsecuentes, el uso del Doppler ecocardiográfico (flujo transmitral y flujo venoso pulmonar) y de las nuevas herramientas en ultrasonido apoyan el diagnóstico de DD. Respecto de las definiciones inciertas, el predominio y pronóstico de la IC diastólica son muy variables. A pesar de tener una baja mortalidad en comparación con la IC sistólica, a largo plazo (más de 5 años) se ha demostrado una mortalidad similar entre los dos tipos de IC. Estudios recientes realizados con los índices diastólicos por Doppler muestran como el poder pronóstico de la relación transmitral E/A < 1 (patrón de relajación anormal) y el > a 1.5 (patrón restrictivo). El tratamiento de la DD del VI e IC no está bien establecido pero los inhibidores de la enzima convertidora de angiotensina, los antagonistas de la aldosterona y los betabloqueantes muestran un potencial beneficio en las propiedades diastólicas del miocardio.

Palabras clave
insuficiencia cardíaca, insuficiencia cardíaca diastólica, disfunción diastólica, ecocardiografía con Doppler, Doppler tisular


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Abstract
Left ventricular (LV) diastolic dysfunction (DD) and diastolic heart failure (HF) develop because of alterations of myocardial diastolic properties. These alterations involve relaxation and/or filling and/or distensibility. Arterial hypertension associated to LV concentric remodelling is the main determinant of DD but several other cardiac diseases, including myocardial ischemia, and extra-cardiac pathologies involving the heart and other possible causes. In the majority of the studies isolated diastolic HF has been made equal to HF with preserved systolic function (= normal ejection fraction) but the true definition of this condition needs a quantitative estimation of LV diastolic properties. According to the Framingham Heart Study, "definite" diastolic heart failure can be diagnosed only by cardiac catheterization while the European Society of Cardiology encourages the use of Doppler echocardiography (transmitral inflow and pulmonary venous flow). In relation to uncertain definitions, both prevalence and prognosis of diastolic heart failure are very variable. Although an apparent lower death rate in comparison with LV systolic HF, long-term follow-up (more than 5 years) seem to show comparable mortality between the two kinds of HF. Recent studies performed by using Doppler diastolic indexes have identified the prognostic power of both transmitral E/A ratio < 1 (pattern of abnormal relaxation) and > 1.5 (restrictive patterns). The therapy of LV DD and HF is not well established but ACE-inhibitors, angiotensin inhibitors, aldosterone antagonists and ß-blockers show potential beneficial effect on diastolic properties.

Key words
heart failure, diastolic heart failure, diastolic dysfunction, Doppler echocardiography, tissue Doppler


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Clasificación en siicsalud
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Especialidades
Principal: Cardiología
Relacionadas: Atención Primaria, Cuidados Intensivos, Diagnóstico por Imágenes, Diagnóstico por Laboratorio, Geriatría, Medicina Interna



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