RESUMEN

Introducción: El ecocardiograma bidimensional transtorácico es una herramienta portátil, no invasiva, con mayor accesibilidad que el cateterismo cardíaco derecho. Brinda múltiples parámetros confiables sobre la hemodinámica pulmonar; sin embargo, la información disponible que respalda el uso del ecocardiograma transtorácico en sujetos con sospecha de hipertensión pulmonar es muy limitada. Material y métodos: Análisis transversal de un estudio de cohorte que incluyó de manera prospectiva y consecutiva la totalidad de individuos con sospecha de hipertensión pulmonar (diferentes del Grupo 2), que fueron evaluados en el Departamento de Neumología y Cirugía de Tórax del Hospital Regional de Alta Especialidad de la Península de Yucatán, México. Resultados: El reporte incluye 52 pacientes con mediana de edad de 52 años (RIC 31-65) y 78% mujeres. Entre los posibles casos atribuibles al Grupo 1, el principal subgrupo lo constituyó el relacionado con enfermedades cardíacas congénitas. Entre las variables ecocardiográficas que pueden permitir un mejor tamizaje de los pacientes con sospecha de hipertensión pulmonar Grupo 1 se observaron: TAPSE (OR 0.82, IC 95% 0.69-0.96) y PsAP (OR 1.08, IC 95% 1.04-1.14). Conclusión: En nuestro medio el uso de ecocardiograma transtorácico es aceptable en la evaluación de los casos con sospecha de hipertensión pulmonar, en particular cuando se evalúan mujeres con historia de enfermedad cardíaca congénita.

PALABRAS CLAVE

Hipertensión pulmonar, enfermedades cardíacas congénitas, función pulmonar, ecocardiografía bidimensional, prevalencia.

REFERENCIAS

1. Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, et al. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S55-S66. https://doi.org/10.1016/j.jacc.2009.04.011

2. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015;46(4):903-975. https://doi.org/10.1183/13993003.01032-2015

3. Klinger JR, Elliott CG, Levine DJ, Bossone E, Duvall L, Fagan K, et al. Therapy for pulmonary arterial hypertension in adults: Update of the CHEST Guideline and Expert Panel Report. Chest. 2019;155(3):565-586. https://doi.org/10.1016/j.chest.2018.11.030

4. McGoon MD, Benza RL, Escribano-Subias P, Jiang X, Miller DP, Peacock AJ, et al. Pulmonary arterial hypertension: epidemiology and registries. J Am Coll Cardiol. 2013;62(25 Suppl):D51-D59. https://doi.org/10.1016/j.jacc.2013.10.023

5. Badesch DB, Raskob GE, Elliott CG, Krichman AM, Farber HW, Frost AE, et al. Pulmonary arterial hypertension: baseline characteristics from the REVEAL registry. Chest. 2010;137(2):376-387. https://doi.org/10.1378/chest.09-1140

6. Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, et al. Pulmonary arterial hypertension in France: results from a national registry. Am J Respir Crit Care Med. 2006; 173(9):1023-1030. https://doi.org/10.1164/rccm.200510-1668oc

7. Alves JL Jr, Gavilanes F, Jardim C, Fernandes CJCDS, Morinaga LTK, Dias B, et al. Pulmonary arterial hypertension in the southern hemisphere: results from a registry of incident Brazilian cases. Chest. 2015;147(2):495-501. https://doi.org/10.1378/chest.14-1036

8. Pulido T, Adzerikho I, Channick RN, Delcroix M, Galiè N, Ghofrani HA, et al. Macitentan and morbidity and mortality in pulmonary arterial hypertension. N Engl J Med. 2013;369(9):809-818. https://doi.org/10.1056/nejmoa1213917

9. Al-Naamani N, Espitia HG, Velazquez-Moreno H, Macuil-Chazaro B, Serrano-Lopez A, Vega-Barrientos RS, et al. Chronic thromboembolic pulmonary hypertension: Experience from a single center in Mexico. Lung. 2016;194(2):315-323. https://doi.org/10.1007/s00408-016-9842-y

10. Calderon-Colmenero J, Sandoval Zárate J, Beltrán Gámez M. [Pulmonary hypertension associated with congenital heart disease and Eisenmenger syndrome]. Arch Cardiol Mex. 2015;85(1):32-49. https://doi.org/10.1016/j.acmx.2014.11.008

11. Mehta S, Sastry BKS, Souza R, Torbicki A, Ghofrani HA, Channick RN, et al. Macitentan improves health-related quality of life for patients with pulmonary arterial hypertension: Results from the randomized controlled SERAPHIN trial. Chest. 2017;151(1):106-118. https://doi.org/10.1016/j.chest.2016.08.1473

12. Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D42-D50. https://doi.org/10.1016/j.jacc.2013.10.032

13. Denis M, Morales-Blanhir JE, Rosas-Romero Mde J, Martínez-Ramírez C. [Relevance of society’s participation in medicine. The case of pulmonary hypertension in Latin America]. Arch Cardiol Mex. 2011;81(1):68-69.

14. Goerne H, Batra K, Rajiah P. Imaging of pulmonary hypertension: an update. Cardiovasc Diagn Ther. 2018;8(3):279-296. https://doi.org/10.21037/cdt.2018.01.10

15. Cordina RL, Playford D, Lang I, Celermajer DS. State-of-the-Art Review: Echocardiography in pulmonary hypertension. Heart Lung Circ 2019;28(9): 1351-1364. https://doi.org/10.1016/j.hlc.2019.03.003

16. Shelburne NJ, Parikh KS, Chiswell K, Shaw LK, Sivak J, Arges K, et al. Echocardiographic assessment of right ventricular function and response to therapy in pulmonary arterial hypertension. Am J Cardiol. 2019;124(8):1298-1304. https://doi.org/10.1016/j.amjcard.2019.07.026

17. Goldberg AB, Mazur W, Kalra DK. Pulmonary hypertension: diagnosis, imaging techniques, and novel therapies. Cardiovasc Diagn Ther. 2017;7(4):405-417. https://doi.org/10.21037/cdt.2017.04.11

18. Li Y, Wang Y, Li H, Zhu W, Meng X, Lu X. Evaluation of the hemodynamics and right ventricular function in pulmonary hypertension by echocardiography compared with right-sided heart catheterization. Exp Ther Med. 2017;14(4): 3616-3622. https://doi.org/10.3892/etm.2017.4953

19. Stenton C. The MRC breathlessness scale. Occup Med (Lond) 2008;58(3): 226-227. https://doi.org/10.1093/occmed/kqm162

20. Taichman DB, McGoon MD, Harhay MO, Archer-Chicko Ch, Sager JS, Murugappan M, et al. Wide variation in clinicians’ assessment of New York Heart Association/World Health Organization functional class in patients with pulmonary arterial hypertension. Mayo Clin Proc. 2009;84(7):586-592. https://doi.org/10.1016/s0025-6196(11)60747-7

21. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-117. https://doi.org/10.1164/ajrccm.166.1.at1102

22. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019;200(8):e70-e88. https://doi.org/10.1164/rccm.201908-1590st

23. Duffels MG, Engelfriet PM, Berger RM, van Loon RLE, Hoendermis E, Vriend JWJ, et al. Pulmonary arterial hypertension in congenital heart disease: an epidemiologic perspective from a Dutch registry. Int J Cardiol. 2007;120(2):198-204. https://doi.org/10.1016/j.ijcard.2006.09.017

24. Engelfriet PM, Duffels MG, Möller T, Boersma E, Tijssen JGP, Thaulow E, et al. Pulmonary arterial hypertension in adults born with a heart septal defect: the Euro Heart Survey on adult congenital heart disease. Heart. 2007;93(6):682-687. https://doi.org/10.1136/hrt.2006.098848

25. Thenappan T, Shah SJ, Rich S, Gomberg-Maitland M. A USA-based registry for pulmonary arterial hypertension: 1982-2006. Eur Respir J. 2007;30(6):1103-1110. https://doi.org/10.1183/09031936.00042107

26. Baltaxe E, Zarante I. [Prevalence of congenital heart disease in 44,985 newborns in Colombia]. Arch Cardiol Mex. 2006;76(3):263-268.

27. Kapoor R, Gupta S. Prevalence of congenital heart disease, Kanpur, India. Indian Pediatr. 2008;45(4):309-311.

28. Mendieta-Alcántara GG, Santiago-Alcántara E, Mendieta-Zerón H, Dorantes-Pina R, Ortiz de Zárate-Alarcón G, Otero-Ojeda GA. [Incidence of congenital heart disease and factors associated with mortality in children born in two Hospitals in the State of Mexico]. Gac Med Mex. 2013;149(6):617-623.

29. Torres-Cosme JL, Rolón-Porras C, Aguinaga-Ríos M, Acosta-Granado PM, Reyes-Muñoz E, Murguía-Peniche T. Mortality from congenital heart disease in Mexico: A problem on the rise. PLoS One. 2016;11(3):e0150422. https://doi.org/10.1371/journal.pone.0150422

30. Boucly A, Weatherald J, Savale L, Jaïs X, Cottin V, Prevot G, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017;50(2):1700889. https://doi.org/10.1183/13993003.00889-2017

31. Leuchte HH, El Nounou M, Tuerpe JC, Hartmann B, Baumgartner RA, Vogeser M, et al. N-terminal pro-brain natriuretic peptide and renal insufficiency as predictors of mortality in pulmonary hypertension. Chest. 2007;131(2):402-409. https://doi.org/10.1378/chest.06-1758

32. de Bold AJ, Borenstein HB, Veress AT, Sonnenberg H. A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats. Life Sci. 1981;28(1):89-94. https://doi.org/10.1016/0024-3205(81)90370-2

33. Salerno D, Marik PE. Brain natriuretic peptide measurement in pulmonary medicine. Respir Med. 2011;105(12):1770-1775. https://doi.org/10.1016/j.rmed.2011.07.013

34. Al-Naamani N, Palevsky HI, Lederer DJ, Horn EM, Mathai SC, Roberts KE, et al. Prognostic significance of biomarkers in pulmonary arterial hypertension. Ann Am Thorac Soc. 2016;13(1): 25-30. https://doi.org/10.1513/annalsats.201508-543oc

35. Low AT, Medford AR, Millar AB, Tulloh RM. Lung function in pulmonary hypertension. Respir Med. 2015;109(10):1244-1249. https://doi.org/10.1016/j.rmed.2015.05.022

36. Jing ZC, Xu XQ, Badesch DB, Jiang X, Wu Y, Liu JM, et al. Pulmonary function testing in patients with pulmonary arterial hypertension. Respir Med. 2009;103(8):1136-1142. https://doi.org/10.1016/j.rmed.2009.03.009

37. Escribano PM, Sánchez MA, de Atauri MJ, Frade JP, García IM. [Lung function testing in patients with pulmonary arterial hypertension]. Arch Bronconeumol. 2005;41(7):380-384. https://doi.org/10.1016/s1579-2129(06)60245-0

38. Farha S, Laskowski D, George D, Park MM, Tang WHW, Dweik RA, et al. Loss of alveolar membrane diffusing capacity and pulmonary capillary blood volume in pulmonary arterial hypertension. Respir Res. 2013;14(1):6. https://doi.org/10.1186/1465-9921-14-6

39. Badagliacca R, Papa S, Valli G, Pezzuto B, Poscia R, Manzi G, et al. Echocardiography combined with cardiopulmonary exercise testing for the prediction of outcome in idiopathic pulmonary arterial hypertension. Chest. 2016;150(6):1313-1322. https://doi.org/10.1016/j.chest.2016.07.036