Palabras clave
Pronóstico
Variabilidad de la frecuencia cardiaca
Estudio de cohortes Myocardial infarction
Prognosis
Heart rate variability
Cohort study
Cómo citar
Resumen
Evaluar la asociación de la variabilidad de la frecuencia cardiaca (VFC) como factor pronóstico de morbi-mortalidad en pacientes en fase aguda (intrahospitalaria) de un infarto del miocardio (IAM). Diseño: estudio de cohorte prospectivo. Población a estudio: se incluyeron 173 pacientes con primer episodio de IAM atendidos en el Hospital Universitario de Santander y en la Fundación Cardiovascular de Colombia del 1 de abril de 2003 al 31 de diciembre del 2007. Se excluyeron pacientes diabéticos y con patologías con afección del sistema nervioso autónomo. Comparaciones: VFC en pacientes con desenlace (morbi-mortalidad) versus estas variables en pacientes sin desenlace. Desenlaces: mortalidad súbita, mortalidad no súbita, angina post-IAM, reinfarto, arritmia cardiaca, insuficiencia cardiaca y complicados versus no complicados. Metodología: la VFC se midió en tres ocasiones consecutivas por espacio de cinco minutos cada una, en las primeras 12 horas de ingreso del paciente al servicio de urgencias. Se utilizó el equipo Biopac MP35 para el registro digital del electrocardiograma. El procesamiento y análisis de la señal fue realizado con el software Prognostic AMI 2.0. (Grupo de Bioingeniería – UIS). Seguimiento: la totalidad de los pacientes incluidos fue seguida desde su ingreso al servicio de urgencias hasta su egreso hospitalario y se evaluó la presencia o no de algún desenlace. Análisis estadístico: para las variables cuantitativas se utilizó medias con desviación estándar, para las cualitativas, proporciones. Las diferencias se evaluaron con t test y chi cuadrado, según el caso. Se realizó un análisis bivariado cuyos resultados se mostraron con riesgos relativos e intervalos de confianza del 95%. Se realizó un análisis de sobrevida utilizando las curvas de Kaplan-Meier y evaluando diferencias por medio del log rank test. Resultados: se incluyeron 173 pacientes con primer IAM. Con edad promedio de 63,11 años (rango entre 28-96). El 55,5% (n: 96) con IAM de cara anterior. El promedio de fracción de eyección fue de 43,8% (SD: 14,52%). Los desenlaces encontrados fueron: angina post-IAM (41.04%), insuficiencia cardiaca (20,81%), arritmia cardiaca (15,61%), muerte no súbita (6,36%), muerte súbita (3,47%) y reinfarto (2,3%). Para insuficiencia cardiaca: una fracción de eyección < 40% mostró un RR 3,26 (IC95%1,76-6,04), una edad mayor de 65 años con RR: 1,89 (IC95% 1,01-3,53), valores bajos de HF con RR 2,36 (IC95% 1,1-5,06), LF RR 2,36 (IC95% 1,1-5,06) y LFnu RR: 2,76 (IC95% 1,15-6,63) y para el desenlace de arritmia cardiaca: bajos valores de MDARR RR:0,25 (IC95% 0,11-0,57), MIRR RR 0,27 (IC95% 0,12-0,62) y PNN50 RR: 0,35 (IC95% 0,16,75) se asociaron de manera significativa como factor protector. Conclusiones: bajos valores de HF, LF y LFnu se asocian significativamente con el desenlace de insuficiencia cardiaca. Por el contrario, bajos valores de MDARR,
MIRR y PNN50 son protectores para el desenlace de arritmias cardiacas en la fase aguda de un infarto del miocardio. La VFC no se encontró asociada a los otros desenlaces como: muerte súbita y no súbita, angina post-infarto, reinfarto y complicaciones globales.
Citas
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