Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio
Resumen
La falla cardiaca con fracción de eyección preservada es frecuente y de difícil abordaje perioperatorio en población adulta. Es un síndrome clínico complejo con alteraciones estructurales y funcionales cardiacas con fracción de eyección del ventrículo izquierdo preservada (FEVI) > 50 %. Los biomarcadores, la ecocardiografía, el cateterismo cardiaco y otros métodos no invasivos confirman el diagnóstico. Actualmente no existe manejo específico efectivo comparado al de la falla con fevi reducida. Objetivo: elaborar una revisión de la literatura sobre la falla cardiaca con fracción de eyección preservada y sus implicaciones anestésicas. Métodos: se realizó una revisión no sistemática de la literatura en las siguientes bases de datos: Pubmed/Medline, LILACS, ScienceDirect. Resultados: la falla cardiaca con fracción de eyección preservada es una entidad común con una prevalencia entre 36,9 % y más del 50 % del total de pacientes. La fisiopatología incluye alteraciones diastólicas del ciclo cardiaco incluyendo las fases de relajación y de compliance ventricular. Desde el punto de vista anestésico se debe mantener el ritmo sinusal en arritmias, controlar la respuesta cronotrópica, evitar congestión pulmonar, manejar específicamente las etiologías-comorbilidades, conservar presiones de llenado ventricular y lograr estabilidad hemodinámica. Conclusión: los pacientes con este síndrome representan un reto anestésico. El manejo incluye tratamiento específico de las etiologías, comorbilidades y fenotipos. A diferencia de la falla cardiaca con fracción de eyección reducida, no existen terapias que disminuyan la mortalidad, por lo que se requieren nuevos fármacos y estudios clínicos que mejoren las perspectivas anestésicas y el abordaje terapéutico.
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Referencias bibliográficas
Inamdar AA, Inamdar AC. Heart failure: diagnosis, management and utilization. J Clin Med. 2016;5(7):62. https://doi.org/10.3390/jcm5070062
Smit-Fun V, Buhre WF. The patient with chronic heart failure undergoing surgery. Curr Opin Anaesthesiol. 2016;29(3):391-396. https://doi.org/10.1097/ACO.0000000000000335
Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(12):1574-1585. https://doi.org/10.1002/ejhf.813
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70(6):776-803. https://doi.org/10.1161/CIR.0000000000000509
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-2200. https://doi.org/10.1093/eurheartj/ehw128
Gladden J, Linke W, Redfield M. Heart failure with preserved ejection fraction. Pflugers Arch. 2014;(466):1037-1053. https://doi.org/10.1007/s00424-014-1480-8
Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933-944. https://doi.org/10.1161/CIR.0b013e31820a55f5
Gómez E. Capítulo 2. Introducción, epidemiología de la falla cardiaca e historia de las clínicas de falla cardiaca en Colombia. Rev Colomb Cardiol. 2016;23(1):6-12. https://doi.org/10.1016/j.rccar.2016.01.004
Gómez EA. Identification of patients with heart failure and preserved systolic function: a regional epidemiological study (I-PREFER Study) - Colombia. Rev Colomb Cardiol. 2013;20(2):58-67. Disponible en http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-56332013000200002
Singh A, Mehta Y. Heart failure with preserved ejection fraction ( HFpEF ): implications for the anesthesiologists. J Anaesthesiol Clin Pharmacol. 2018;34(2):161-165. https://doi.org/10.4103/joacp.JOACP_352_16
Dawber TR, Kannel WB, Lye LP. An approach to longitudinal studies in a community: the Framingham Study. Ann New York Acad Sci. 1963;107(2):539-556. https://doi.org/10.1111/j.1749-6632.1963.tb13299.x
Psaty BM, Kuller LH, Bild D, Burke GL, Kittner SJ, Price TR, et al. Methods of assessing prevalent cardiovascular health study cardiovascular disease in the cardiovascular health study. Ann Epidemiol. 1995;5(4):270-277. https://doi.org/10.1016/1047-2797(94)00092-8
Diercks GFH, Janssen WMT, van Boven AJ, Bak AAA, De Jong PE, Crijns HJGM, et al. Rationale, design, and baseline characteristics of a trial of prevention of cardiovascular and renal disease with fosinopril and pravastatin in nonhypertensive, nonhypercholesterolemic subjects with microalbuminuria (the prevention of REnal and vascular ENdstage disease intervention trial [PREVEND IT]). Am J Cardiol. 2000;86(6):635-638. https://doi.org/10.1016/S0002-9149(00)01042-0
Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;(14):591-602. https://doi.org/10.1038/nrcardio.2017.65
Steinberg BA, Zhao X, Heidenreich PA, Peterson ED, Bhatt DL, Cannon CP, et al. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation. 2012;126(1):65-75. https://doi.org/10.1161/CIRCULATIONAHA.111.080770
Pérez de Isla L, Cañadas V, Contreras L, Almería C, Rodrigo JL, Aubele AL, et al. Diastolic heart failure in the elderly: In-hospital and long-term outcome after the first episode. Int J Cardiol. 2009;134(2):265-270. https://doi.org/10.1016/j.ijcard.2007.12.059
Gerber Y, Weston SA, Redfield MM, Chamberlain AM, Manemann SM, Jiang R, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med. 2015;175(6):996-1004. https://doi.org/10.1001/jamainternmed.2015.0924
Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the National Heart, Lung, and Blood Institute. Circulation. 2009;119(24):3070-3077. https://doi.org/10.1161/CIRCULATIONAHA.108.815944
Royce-Nagel G, Karamchandani K. Pulmonary edema and diastolic heart failure in the perioperative period. Case Rep Anesthesiol. 2018;2018:1-3. https://doi.org/10.1155/2018/5101534
Afilalo J, Flynn AW, Shimony A, Rudski LG, Agnihotri AK, Morin JF, et al. Incremental value of the preoperative echocardiogram to predict mortality and major morbidity in coronary artery bypass surgery. Circulation. 2013;127(3):356-364. https://doi.org/10.1161/CIRCULATIONAHA.112.127639
Fayad A, Ansari MT, Yang H, Ruddy T, Wells GA. Perioperative diastolic dysfunction in patients undergoing noncardiac surgery is an independent risk factor for cardiovascular events: a systematic review and meta-analysis. Anesthesiology. 2016;125(1):72-91. https://doi.org/10.1097/ALN.0000000000001132
Redfield MM. Heart failure with preserved ejection fraction. N Engl J Med. 2016;375(19):1868-1877. https://doi.org/10.1056/NEJMcp1511175
Crijns H, Van der Wall E. Diastolic function: physiology, methods and clinical significance. Groningen: group on cardiovascular research the netherlands. Chapter 2. Diastolic function: physiology, methods and clinical significance; p. 6-28.
Gorter TM, van Veldhuisen DJ, Bauersachs J, Borlaug BA, Celutkiene J, Coats AJS, et al. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20(1):16-37. https://doi.org/10.1002/ejhf.1029
Chatterjee K. Pathophysiology of systolic and diastolic heart failure. Med Clin North Am. 2012;96(5):891-899. https://doi.org/10.1016/j.mcna.2012.07.001
Kovács SJ. Diastolic function in heart failure. Clin Med Insights Cardiol. 2015;9(Suppl 1):49-55. https://doi.org/10.4137/CMC.S18743
Pfeffer MA, Shah AM, Borlaug BA. Heart failure with preserved ejection fraction in perspective. Circ Res. 2019;124(11):1598-1617. https://doi.org/10.1161/CIRCRESAHA.119.313572
Mesquita ET, Barbetta LMDS, Correia ET de O. Heart failure with mid-range ejection fraction - State of the art. Arq Bras Cardiol. 2019;112(6):784-790. https://doi.org/10.5935/abc.20190079
Pieske B, Tschöpe C, De Boer RA, Fraser AG, Anker SD, Donal E, et al. How to diagnose heart failure with preserved ejection fraction: The HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40(40):3297-3317. https://doi.org/10.1093/eurheartj/ehz641
Zakeri R, Chamberlain AM, Roger VL, Redfield MM. Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study. Circulation. 2013;128(10):1085-1093. https://doi.org/10.1161/CIRCULATIONAHA.113.001475
Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y, et al. B-Type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure. J Am Coll Cardiol. 2006;47(4):742-748. https://doi.org/10.1016/j.jacc.2005.11.030
Grewal J, Mckelvie RS, Persson H, Tait P, Carlsson J, Swedberg K, et al. Usefulness of N-Terminal Pro-Brain natriuretic peptide and brain natriuretic peptide to predict cardiovascular outcomes in patients with heart failure and preserved left ventricular ejection fraction. Am J Cardiol. 2008;102(6):733-737. https://doi.org/10.1016/j.amjcard.2008.04.048
Reddy YN, Carter R, Obokata M, Redfield MM, Borlaug, BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138(9):861-870. https://doi.org/10.1161/CIRCULATIONAHA.118.034646
Gard E, Nanayakkara S, Kaye D, Gibbs H. Management of heart failure with preserved ejection fraction. Aust Prescr. 2020;43(1):12-17. https://doi.org/10.18773/austprescr.2020.006
Oren O, Goldberg S. Heart failure with preserved ejection fraction: diagnosis and management. Am J Med. 2017;130(5):510-516. https://doi.org/10.1016/j.amjmed.2016.12.031
Upadhya B, Pisani B, Kitzman DW. Evolution of a Geriatric Syndrome: pathophysiology and treatment of heart failure with preserved ejection fraction. J Am Geriatr Soc. 2017;65(11):2431-2440. https://doi.org/10.1111/jgs.15141
Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJV, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. The Lancet. 2003;362(9386):777-781. https://doi.org/10.1016/S0140-6736(03)14285-7
Cleland JGF, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27(19):2338-2345. https://doi.org/10.1093/eurheartj/ehl250
Massie BM, Carson PE, Mcmurray JJ, Komajda M, McKelvie R, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359(23):2456-2467. https://doi.org/10.1056/NEJMoa0805450
Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392. https://doi.org/10.1056/NEJMoa1313731
Illesiu AM, Hodorogea AS. Treatment of heart with preserved ejection fraction. Adv Exp Med Biol. 2018;1067:67-87. https://doi.org/10.1007/5584_2018_149
Komajda M, Isnard R, Cohen-Solal A, Metra M, Pieske B, Ponikowski P, et al. Effect of ivabradine in patients with heart failure with preserved ejection fraction: the EDIFY randomized placebo-controlled trial. Eur J Heart Fail. 2017;19(11):1495-1503. https://doi.org/10.1002/ejhf.876
Garg R, Gorlin R, Smith T, Yusuf S. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336(8):525-533. https://doi.org/10.1056/NEJM199702203360801
Redfield MM, Anstrom KJ, Levine JA, Koepp GA, Borlaug BA, Chen HH, et al. Isosorbide mononitrate in heart failure with preserved ejection fraction. N Engl J Med. 2015;373(24):2314-2324. https://doi.org/10.1056/NEJMoa1510774
Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G, et al. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. JAMA - J Am Med Assoc. 2013;309(12):1268-1277. https://doi.org/10.1001/jama.2013.2024
Solomon SD, Zile M, Pieske B, Voors A, Shah A, Kraigher-Krainer E, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. The Lancet. 2012;380(9851):1387-1395. https://doi.org/10.1016/S0140-6736(12)61227-6
Maier LS, Layug B, Karwatowska-Prokopczuk E, Belardinelli L, Lee S, Sander J, et al. RAnoLazIne for the treatment of diastolic heart failure in patients with preserved ejection fraction. The RALI-DHF proof-of-concept study. JACC Hear Fail. 2013;1(2):115-122. https://doi.org/10.1016/j.jchf.2012.12.002
Aldeano AA, Garay A, Alcoberro L, Marreno SJ, Yun S, et al. Iron deficiency: impact on functional capacity and quality of life in heart failure with preserved ejection fraction. J Clin Med. 2020;9(4):1199. https://doi.org/10.3390/jcm9041199
Streng KW, Nauta JF, Hillege HL, Anker SD, Cleland JG, Dickstein K, et al. Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction. Int J Cardiol. 2018;271(2017):132-139. https://doi.org/10.1016/j.ijcard.2018.04.001
Mentz RJ, Kelly JP, Von Lueder TG, Voors AA, Lam CSP, Cowie MR, et al. Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol. 2014;64(21):2281-2293. https://doi.org/10.1016/j.jacc.2014.08.036
Sasha KS, Chacon MM, Brakke TF, Roberts EK, Schulte TE, Markin N. Heart failure with preserved ejection fraction: a perioperative review. J Cardiothorac Vasc Anesth. 2017; 31(5):1820-1830. https://doi.org/10.1053/j.jvca.2017.06.009
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert S De, et al. Grupo de trabajo conjunto sobre cirugía no cardiaca: evaluación y manejo cardiovascular de la Sociedad Europea de Cardiología (ESC) y la European Society of Anesthesiology (ESA). Rev Esp Cardiol. 2014;67(12):1052.el-1052.e43. https://doi.org/10.1016/j.recesp.2014.11.001
Harper AR, Patel HC, Lyon AR. Heart failure with preserved ejection fraction. Clin Med (London). 2018;18(Suppl 2):s24-s29. https://doi.org/10.7861/clinmedicine.18-2-s24
Kjeldsen SE, von Lueder TG, Smiseth OA, Wachtell K, Mistry N, Westheim AS, et al. Medical therapies for heart failure with preserved ejection fraction. Hypertension. 2020;75(1):23-32. https://doi.org/10.1161/HYPERTENSIONAHA.119.14057
Jørgensen ME, Andersson C, Venkatesan S, Sanders RD. Beta-blockers in non-cardiac surgery: did observational studies put us back on safe ground? 2018;121(1):16-25. https://doi.org/10.1016/j.bja.2018.02.004
Fleisher LA, Fleischmann KE, Auerbach MD, Nelson MT, Spencer CC, Thompson A, et al. 2014 ACC / AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. 2014;64(22): e77-e137. https://doi.org/10.1016/j.jacc.2014.07.944
Arora P, Pourafkari L, Visnjevac O, Anand EJ, Porhomayon J, Nader ND. Preoperative serum potassium predicts the clinical outcome after non-cardiac surgery. Clin Chem Lab Med. 2017;55(1):145-153. https://doi.org/10.1515/cclm-2016-0038
Zhu Q, Li X, Tan F, Deng Y, Gong C, Hu J, et al. Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery. BMC Gastroenterol. 2018;18(1):152. https://doi.org/10.1186/s12876-018-0876-x
Nicoara A, Whitener G, Swaminathan M. Perioperative diastolic dysfunction: a comprehensive approach to assessment by transesophageal echocardiography. Semin Cardiothorac Vasc Anesth. 2014;18(2):218-236. https://doi.org/10.1177/1089253213505686
Ryu T, Song SY. Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist's perspective. Korean J Anesthesiol. 2017;70(1):3-12. https://doi.org/10.4097/kjae.2017.70.1.3
Filipovic M, Michaux I, Wang J, Hunziker P, Skarvan K, Seeberger M. Effects of sevoflurane and propofol on left ventricular diastolic function in patients with pre-existing diastolic dysfunction. Br J Anaesth. 2007;98(1):12-8. https://doi.org/10.1093/bja/ael277
Rupert E, Sarkar S, GuhaBiswas R. Echocardiographic evaluation and comparison of the effects of isoflurane, sevoflurane and desflurane on left ventricular relaxation indices in patients with diastolic dysfunction. Ann Card Anaesth. 2010;13(2):130-137. https://doi.org/10.4103/0971-9784.62945
Bolliger D, Seeberger MD, Kasper J, Skarvan K, Seeberger E, Lurati Buse G, et al. Remifentanil does not impair left ventricular systolic and diastolic function in young healthy patients. Br J Anaesth. 2011;106(4):573-579. https://doi.org/10.1093/bja/aeq414
Sanfilippo F, Scolletta S, Morelli A, Baron AV. Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care. Ann Intensive Care. 2018;(8):100. https://doi.org/10.1186/s13613-018-0447-x
Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71. https://doi.org/10.1016/j.jacc.2013.02.092
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