Determinantes clínicos de la presión de fin de diástole / Clinical determining factors of the end of diastole's pressure

RESUMEN

Introducción: la falla cardiaca sobreviene a los pacientes con múltiples enfermedades cardiovasculares. Se encuentra con frecuencia, que algunos pacientes no empeoran su clase funcional, a pesar de reunir condiciones clínicas que suponen una severa alteración fisiopatológica. Estos hallazgos son confirmados al medir la presión de fin de diástole (PFD) en el laboratorio de hemodinamia. Objetivo: determinar qué factores clínicos inciden en la PFD.Material y métodos: estudio retrospectivo, descriptivo de 200 pacientes estudiados (muestra aleatoria de 1730 pacientes) durante el año 2005, con análisis de las relaciones entre la variable dependiente PFD y las variables independientes edad, sexo, peso, superficie corporal, factores de riesgo, cuadro clínico, fracción de eyección (FE), alteraciones estructurales ventriculares (dilatación o hipertrofia), compromiso coronario (uno, dos o tres vasos, angiográficamente sanos, o presencia de flujo lento intracoronario), y la arteria coronaria comprometida. Se aplicó un modelo de regresión lineal simple mediante el paquete estadístico STATA Versión 9...

ABSTRACT

Introduction: many cardiovascular diseases may cause heart failure, because of impairment of systolic or diastolic function, or both. It is frequently observed that regardless of physiopathological processes that were presumed to cause major symptoms, some patients have normal orquite normal functional class of dyspnea. This observation is sometimes confirmed in the cath lab, when the measured end diastolic pressure (EDP) is normal.Objective: to study which clinical factors are related with changes in EDP.Methods: 200 patients were included in a sample of 1.730 patients studied in the Cath Lab during 2005. This retrospective, descriptive and analytic study seeked for association betweenEDP and independent variables such as age, sex gender, weight, clinical risk factor for coronary artery disease, the clinical presentation, ejection fraction (EF) measured, structural changes inleft ventricle morphology (dilatation or hypertrophy), extent of coronary disease (one, two or three-vessel disease, normal coronaries, or reduced intracoronary flow), and the coronary artery involved. Statistically, a simple linear regression model was applied in the STATA 9 program Results: increasing variability in the EDP was found to be significantly related with hypertension, dilated left ventricle, 3-vessel disease, left coronary descendant and right coronary artery involvement. Decreasing variability of EDP presented with increasing EF and normal coronaryarteries. Conclusions: some clinical factors were confirmed as related with altered EDP, but others, such as the more unstable clinical conditions and hypertrophy, surprisingly showed no significant relation with EDP variations. This investigation offers new pathways to future clinical studies inthis area.