Publication: Eficacia Clínica de la Ecocardiografía y la Resonancia Magnética cardiaca en la Insuficiencia Aórtica
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2021-07-21
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Universidad Complutense de Madrid
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Abstract
La insuficiencia aórtica (IAo) crónica es una valvulopatía caracterizada por el retorno diastólico de sangre procedente de la aorta hacia el ventrículo izquierdo (VI) secundario a alteraciones de la válvula y/o la raíz aórtica. Esta alteración hemodinámica condiciona una serie de cambios anatómicos y fisiopatológicos que conducen a la aparición de síntomas y remodelado ventricular progresivo. Se trata de una enfermedad habitualmente insidiosa y de larga evolución. La decisión clínica más compleja en la atención de esta cardiopatía es identificar el momento óptimo para su resolución quirúrgica. De acuerdo a la evidencia actual, esta decisión se fundamenta en el inicio de los síntomas, la identificación de disfunción ventricular izquierda o criterios de dilatación por encima de unos umbrales establecidos. Las técnicas de imagen juegan un papel esencial en su diagnóstico, así como en el despistaje precoz de estos signos de claudicación de VI. Entre estas, el ecocardiograma, al ser una técnica no invasiva, de elevada disponibilidad y bajo coste, constituye la primera elección. Sin embargo, en los últimos años han irrumpido en el armamentario del diagnóstico clínico nuevas tecnologías de imagen. En concreto, la resonancia magnética cardiaca (RMC) se ha perfilado como una de las técnicas más prometedoras en el estudio de la patología valvular, por su excelente capacidad para el estudio de volúmenes y función ventricular, así como por la posibilidad de cuantificar los flujos mediante el contraste de fase.
Estudios previos han evidenciado la superior eficacia técnica de la RMC frente al ecocardiograma transtorácico (ETT) en la gradación de la severidad de la IAo y la valoración de su repercusión sobre el VI. Este paso, aunque imprescindible, es aún una fase muy inicial en el proceso jerárquico que deben seguir las técnicas de diagnóstico hacia su implementación. Por ello, el objetivo de la presente Tesis Doctoral fue realizar un estudio comparativo “cara a cara” entre el ETT y la RMC en términos de eficacia clínica en pacientes con IAo crónica. El concepto de eficacia clínica engloba no solo la precisión diagnóstica sino también la eficacia diagnóstica y terapéutica...
Chronic aortic regurgitation (AR) is characterized by diastolic reflux of blood from the aorta into the left ventricle (LV) due to valve or aortic root distortion. This hemodynamic alteration produces anatomical and pathophysiological changes that lead to progressive ventricular remodeling and eventually, development of symptoms. It is usually an insidious and progressive disease. The most difficult clinical decision in AR is timing the surgical correction. Currently, the intervention is recommended whenever symptoms or LV dysfunction appear or LV dilation reaches previously established limits of LV size. Thus, imaging techniques play an essential role in the diagnosis and follow-up of AR patients, to provide early detection of signs of LV damage. Among them, easy access, noninvasiveness and its low cost, render transthoracic echocardiography (TTE) as the mostly recommended imaging modality. However, recent improvement of new technologies has have led to the irruption of multimodality imaging in cardiovascular medicine. Specifically, cardiac magnetic resonance (CMR) has become one of the most promising techniques to characterize valvular heart diseases due to its accuracy for monitoring LV volumes and function, as well as its ability to quantify blood flow using phase contrast. Previous studies have demonstrated the superior technical efficacy of CMR over TTE in stratifying AR severity and analyzing its impact on the LV. This evidence, although essential, is still at a very initial stage in the hierarchical efficacy assessment framework recommended for the adoption of any novel medical imaging technique. Therefore, the main aim of this study was to undergo a formal face-to-face comparison between CMR and TTE in terms of clinical efficacy in patients with chronic AR. This concept encompasses not only diagnostic precision and accuracy but also diagnostic and therapeutic efficacy...
Chronic aortic regurgitation (AR) is characterized by diastolic reflux of blood from the aorta into the left ventricle (LV) due to valve or aortic root distortion. This hemodynamic alteration produces anatomical and pathophysiological changes that lead to progressive ventricular remodeling and eventually, development of symptoms. It is usually an insidious and progressive disease. The most difficult clinical decision in AR is timing the surgical correction. Currently, the intervention is recommended whenever symptoms or LV dysfunction appear or LV dilation reaches previously established limits of LV size. Thus, imaging techniques play an essential role in the diagnosis and follow-up of AR patients, to provide early detection of signs of LV damage. Among them, easy access, noninvasiveness and its low cost, render transthoracic echocardiography (TTE) as the mostly recommended imaging modality. However, recent improvement of new technologies has have led to the irruption of multimodality imaging in cardiovascular medicine. Specifically, cardiac magnetic resonance (CMR) has become one of the most promising techniques to characterize valvular heart diseases due to its accuracy for monitoring LV volumes and function, as well as its ability to quantify blood flow using phase contrast. Previous studies have demonstrated the superior technical efficacy of CMR over TTE in stratifying AR severity and analyzing its impact on the LV. This evidence, although essential, is still at a very initial stage in the hierarchical efficacy assessment framework recommended for the adoption of any novel medical imaging technique. Therefore, the main aim of this study was to undergo a formal face-to-face comparison between CMR and TTE in terms of clinical efficacy in patients with chronic AR. This concept encompasses not only diagnostic precision and accuracy but also diagnostic and therapeutic efficacy...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 09/02/2021