PARTICULARITĂȚILE EVOLUȚIEI HIPERTENSIUNII PULMONARE LA PACIENȚII CU INSUFICIENȚĂ CARDIACĂ ISCHEMICĂ PE PARCURSUL A 12 LUNI DUPĂ REVASCULARIZARE MIOCARDICĂ
DOI:
https://doi.org/10.52692/1857-0011.2024.1-78.02Cuvinte cheie:
hipertensiune pulmonară, probabilitate ecocardiografică de hipertensiune pulmonară, revascularizare miocardică, insuficiență cardiacă ischemicăRezumat
Hipertensiunea pulmonară (HTP) secundară bolilor cordului stâng este frecventă și are un impact important asupra progresiei bolii, morbidității și mortalității.Scop: identificarea particularităților evoluției HTP la pacienții cu insuficiență cardiacă ischemică pe parcursul a 12 luni după revascularizare miocardică (MRev) prin by-pass coronarian sau angioplastie coronariană percutană. Metode: Cercetarea a inclus 281 pacienți supuși MRev (vârsta medie=63,2±9,7ani, 76,5%- bărbați), supravegheați timp de 12,6±1,6luni. Pacienții au fost divizați în funcție de probabilitatea ecocardiografică HTP (PrHTP) în 3 grupuri: PrHTP mică (117 pacienți), PrHTP intermediară (74 bolnavi), PrHTP înaltă (90 pacienți). Rezultate. Prevalența HTP la 12 luni după MRev a consitutuit 69,7%, majorându-se cu 10% comparativ cu perioada inițială. S-a atestat o evoluție negativă a PrHTP pe parcursul 1 an după MRev, manifestată prin creșterea gradului de PrHTP la 42,8% dintre bolnavii cu PrHTP mică inițial și 54,1% dintre cei cu PrHTP intermediară. Velocitatea maximă a regurgitării tricuspide și presiunea sistolică în artera pulmonară nu s-au modificat semnificativ pe parcursul a 12 luni. Evoluția negativă a PrHTP a fost determinată de dinamica negativă a semnelor ecocardiografice adiționale sugestive pentru HTP: aria atriului drept (+2,2±0,4mm), timpul de accelerare în tractul de ejecție al ventriculului drept (-7,6±1,2ms), diametrul venei cave inferioare (+0,55±0,2mm). Pe parcursul a 12 luni după MRev au decedat 5 pacienți, toți fiind cu PrHTP înaltă (p<0.01), iar rata spitalizărilor în acest grup a fost semnificativ mai mare (PrHTP înaltă - 57,1%, PrHTP intermediară - 43,2%, PrHTP mică - 38,7%, p<0.05). Concluzii: Prevalența HTP la 12 luni după MRev a consitutuit 69,7%, majorându-se cu 10% comparativ cu perioada inițială. S-a remarcat o evoluție negativă a PrHTP în acest interval de timp. Pacienții cu PrHTP înaltă și intermediară au avut o rată mai mare de spitalizări pe parcursul a 12 luni după MRev, iar toți pacienții decedați au avut PrHTP înaltă.
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