Revascularización en disfunción del ventrículo izquierdo
DOI:
https://doi.org/10.47487/apcyccv.v2i1.112Palabras clave:
disfunción del ventrículo izquierdo, viabilidad, Revascularización miocárdicaResumen
La disfunción del ventrículo izquierdo por remodelación adversa constituye la condición anatómica estructural subyacente de la insuficiencia cardíaca y es la secuela principal, y más severa, de la enfermedad arterial coronaria a largo plazo; además, es la única patología que se puede beneficiar con la revascularización miocárdica quirúrgica. Para su control existen guías actuales de tratamiento médico sustentados en los resultados favorables de ensayos clínicos contemporáneos. Sin embargo, en estudios recientes, no hubo beneficio de la revascularización quirúrgica sumada a la terapia médica óptima al compararse con la terapia médica óptima sola. La identificación de la viabilidad miocárdica para guiar la revascularización tampoco fue favorable. Los resultados de la extensión de estos ensayos evidenciaron beneficio del tratamiento de revascularización, pero la detección de viabilidad permaneció sin ser favorable. El aumento de la fracción de eyección del ventrículo izquierdo, como marcador de beneficio de la revascularización, no se asoció con menor mortalidad. Existen muchas razones por las cuales las ventajas conocidas de la revascularización no fueron evidenciadas. A pesar de estas discrepancias, la revascularización miocárdica y la identificación de viabilidad en estos pacientes tienen sustento y suelen ser indicaciones de tratamiento habituales.
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