Mecanismos fisiopatológicos, neurohormonales y objetivos terapéuticos en la insuficiencia cardiaca aguda

Christian Osmar Chávez-Alfonso, Osmar Antonio Centurión

Resumen


La insuficiencia cardiaca aguda (ICA) se define como la aparición rápida o el empeoramiento de los síntomas o signos de IC. Es una entidad potencialmente mortal que requiere evaluación y tratamiento urgentes y típicamente conlleva la hospitalización urgente. La descompensación de la insuficiencia cardiaca crónica puede ocurrir sin que existan factores desencadenantes conocidos. Se produce una disfunción endotelial que puede deberse a un desequilibrio en el medio neuro-hormonal, inflamatorio, y oxidativo en la circulación y en las células endoteliales. Se produce clínicamente hipoperfusión miocárdica, reducción del flujo coronario, disfunción isquémica, aumento de la rigidez vascular y deterioro de la distensibilidad arterial que agravan en mayor medida la lesión miocárdica. La evaluación inicial y la monitorización no invasiva continua de las funciones vitales cardiorrespiratorias son esenciales. Los diuréticos son la piedra angular del tratamiento de los pacientes con ICA y signos de sobrecarga de fluidos y congestión. La terapia de reemplazo renal se debe reservar para pacientes que no responden al tratamiento con diuréticos. Los vasodilatadores intravenosos son los segundos fármacos más utilizados en la ICA para el alivio de los síntomas; sin embargo, no existen pruebas definitivas que confirmen su efecto beneficioso. El uso de inotrópicos debería estar reservado a los pacientes con disfunción sistólica que afecta a la perfusión de órganos vitales. Los dispositivos de asistencia ventricular y otras formas de asistencia mecánica circulatoria pueden emplearse como tratamiento puente en pacientes seleccionados.


Palabras clave


Insuficiencia cardiaca aguda, fisiopatológía; manejo terapéutico.

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Referencias


Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. Rev Esp Cardiol. 2016; 69(12):1167.

Yancy CW, Jessup M, Bozkurt B, Butler J., Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128 (16):1810-52.

Martindale JL, Wakai A, Collins SP, Levy PD, Diercks D, Hiestand BC, et al. Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Academic Emergency Medicine 2016;23:223–242.

Ponikowski P, Jankowska E. Patogenia y presentación clínica de la insuficiencia cardiaca aguda. Rev Esp Cardiol. 2015; 68(4):331-337.

AlHabib KF, Elasfar AA, Alfaleh H, Kashour T, Hersi A, AlBackr H, et al. Clinical features, management, and short- and long-term outcomes of patients with acute decompensated heart failure: phase I results of the HEARTS database. Eur J Heart Fail. 2014;16(4):461-9.

Panduranga P, Sulaiman K, Al-Zakwani I, Alazzawi AA, Abraham A, Singh PP, et al. Demographics, Clinical Characteristics, Management, and Outcomes of Acute Heart Failure Patients: Observations from the Oman Acute Heart Failure Registry. Oman Med J. 2016;31(3):188-95.

Gysele S, Bleuminka AM, Knetscha MCJM, Sturkenboom SMJM, Strausa A, Hofmann JW, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. European Heart Journal (2004) 25, 1614–1619.

Fonarow GC, Abraham WT, Albert NM, Gattis SW, Gheorghiade M, Greenberg BH, et al. OPTIMIZE-HF Investigators and Hospitals. Influence of a Performance-Improvement Initiative on Quality of Care for Patients Hospitalized With Heart FailureResults of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med. 2007;167(14):1493-1502.

Parenica J, Spinar J, Vitovec J, Widimsky P, Linhart A, Fedorco M, et al. Long-term survival following acute heart failure: The Acute Heart Failure Database Main registry (AHEAD Main). European Journal of Internal Medicine 2013 24, (2), 151-160.

Purek L, Laule-Kilian K, Christ A, Klima T, Pfisterer M, Perruchoud A, Mueller C. Coronary artery disease and outcome in acute congestive heart failure. Heart 2006;92:598–602.

Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Survey Investigators; Heart Failure Association, European Society of Cardiology. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725-36.

Steg PG, Dabbous OH, Feldman LJ, Cohen-Solal A, Aumont MC, Lopez-Sendon J, et al. Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Events (GRACE). Circulation. 2004;109(4):494–9.

AlFaleh H, Elasfar AA, Ullah A, AlHabib KF, Hersi A, Mimish L, et al. Acute heart failure with and without acute coronary syndrome: clinical correlates and prognostic impact (From the HEARTS registry). BMC Cardiovasc Disord. 2016;16:98.

Tarvasmäki T, Harjola VP, Nieminen MS, Siirilä-Waris K, Tolonen J, Tolppanen H, Lassus J. FINN-AKVA Study Group. Acute heart failure with and without concomitant acute coronary syndromes: patient characteristics, management, and survival. J Card Fail. 2014;20(10):723-30.

Djousse L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA 2009;302:394–400.

Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Leiro MC, Drozdz J, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013;15:808–17.

Crespo-Leiro MG, Anker SD, Maggioni AP, Coats AJ, Filippatos G, Ruschitzka F, et al. Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail. 2016;18(6):613-25.

Ammar KA, Jacobsen SJ, Mahoney DW, Kors JA, Redfield MM, Burnett JC Jr, Rodeheffer RJ. Prevalence and prognostic significance of heart failure stages: application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community. Circulation. 2007; 115(12):1563-70.

Felker GM, Mentz RJ, Teerlink JR, Voors AA, Pang PS, Ponikowski P, et al. Serial high sensitivity cardiac troponin T measurement in acute heart failure: insights from the RELAX-AHF study. Eur J Heart Fail. 2015;17:1262–70

O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):485-510.

Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, et al. American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-228.

Roberts E, Ludman AJ, Dworzynski K, Al-Mohammad A, Cowie MR, McMurray JJV, et al. The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ 2015;350:h910 doi: 10.1136/bmj.h910.

Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-segment Elevation. Rev Esp Cardiol. 2015;68(12):1125.

Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033-69.

Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, et al. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail. 2015; 17(6):544-58.

Prins KW, Neill JM, Tyler JO, Eckman PM, Duval S. Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis. JACC Heart Fail. 2015;3(8):647-53.

Faris RF, Flather M, Purcell H, Poole-Wilson PA, Coats AJ. Diuretics for heart failure. Cochrane Database Syst Rev. 2012;2: CD003838.

King JB, Bress AP, Reese AD, Munger MA. Neprilysin inhibition in heart failure with reduced ejection fraction: a clinical review. Pharmacother J Hum Pharmacol Drug Ther. 2015;35:823–37.

McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau J, Shi VC, Solomon SD, Swedberg K, Zile MR; PARADIGM-HF Committees and Investigators. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Eur J Heart Fail. 2013;15(9):1062-73.

Sulaiman K, Panduranga P, Al-Zakwani I, Alsheikh-Ali AA, AlHabib KF, Al-Suwaidi J, et al. Rationale, Design, Methodology and Hospital Characteristics of the First Gulf Acute Heart Failure Registry (Gulf CARE). Heart Views. 2014;15(1):6-12.

Spinar J, Parenica J, Vitovec J, Widimsky P, Linhart A, Fedorco M, et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry. Crit Care. 2011;15(6):R291.

Follath F, Yilmaz MB, Delgado JF, Parissis JT, Porcher R, Gayat E, et al. Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Intensive Care Med. 2011;37(4):619-26.

Milazzo V, Cosentino N, Marenzi G. Extracorporeal ultrafiltration for acute heart failure: patient selection and perspectives. Vasc Health Risk Manag 2017;13: 449-56.

Greenberg G, Cohen E, Garty M, Iakobishvili Z, Sandach A, Behar S, et al. Outcomes of acute heart failure associated with acute coronary syndrome versus other causes. Acute Card Care. 2011;13(2):87-92.

Shah RV, Holmes D, Anderson M, Wang TY, Kontos MC, Wiviott SD, Scirica BM. Risk of heart failure complication during hospitalization for acute myocardial infarction in a contemporary population: insights from the National Cardiovascular Data ACTION Registry. Circ Heart Fail. 2012;5(6):693-702.

Flaherty JD, Bax JJ, De Luca L, Rossi JS, Davidson CJ, Filippatos G, et al. Acute Heart Failure Syndromes International Working Group. Acute heart failure syndromes in patients with coronary artery disease early assessment and treatment. J Am Coll Cardiol. 2009;53(3):254-63.

Ferreira J. Vascular phenotypes of acute decompensated vs. new-onset heart failure: treatment implications. ESC Heart Failure 2017; 4: 679-85.

Sulo G, Igland J, Nygård O, Vollset SE, Ebbing M, Poulter N, et al. Prognostic Impact of In-Hospital and Postdischarge Heart Failure in Patients With Acute Myocardial Infarction: A Nationwide Analysis Using Data From the Cardiovascular Disease in Norway (CVDNOR) Project. J Am Heart Assoc. 2017;6(3). pii: e005277.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62: e147-e239.

Zheng SL, Chan FT, Nabeebaccus AA, Shah AM, McDonagh T, Okonko DO, et al. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: A systematic review and meta-analysis. Heart 2018; 104: 407-15.

Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: A report from the OPTIMIZE-HF Registry. J Am Coll Cardiol 2007; 50: 768-77.

Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: A report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. JAm Coll Cardiol 2006; 47:76-84.

Toma M, Ezekowitz JA, Bakal JA, O’Connor CM, Hernandez AF, Sardar MR, et al. The relationship between left ventricular ejection fraction and mortality in patients with acute heart failure: Insights from the ASCEND-HF Trial. Eur J Heart Fail 2014; 16:334-41.

Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF, et al. Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. JACC Heart Fail 2016;4: 464-72.

Cheng RK, Cox M, Neely ML, Heidenreich PA, Bhatt DL, Eapen ZJ, et al. Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population. Am Heart J 2014; 168: 721-30.

Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T, et al. Characterization of heart failure patients with mid-range left ventricular ejection fraction: A report from the CHART-2 Study. Eur J Heart Fail 2017; 19: 1258-1269.

Hsu JJ, Ziaeian B, Fonarow GC. Heart failure with mid-range (borderline) ejection fraction: Clinical implications and future directions. JACC Heart Fail 2017;5:763-771.

Lund LH, Claggett B, Liu J, Lam CS, Jhund PS, Rosano GM, et al. Heart failure with mid-range ejection fraction in CHARM: Characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum. Eur J Heart Fail 2018;20:1230-1239.

Hernandez AF, Hammill BG, O’Connor CM, Schulman KA, Curtis LH, Fonarow GC. Clinical effectiveness of beta-blockers in heart failure: Findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol 2009; 53: 184-192.

Yamamoto K, Origasa H, Hori M. Effects of carvedilol on heart failure with preserved ejection fraction: The Japanese Diastolic Heart Failure Study (J-DHF). Eur J Heart Fail 2013; 15: 110-118.

Gattis WA, O'Connor CM. Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure. Am J Cardiol 2004; 93: 74B-76B.

Jondeau G, Neuder Y, Eicher JC. B-CONVINCED: Betablocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J 2009; 30: 2186-292.


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