{"id":117978,"date":"2018-03-11T10:47:44","date_gmt":"2018-03-11T10:47:44","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/nuevos-metodos-para-predecir-la-gravedad-y-el-pronostico-de-la-estenosis-aortica-calcificada-asintomatica\/"},"modified":"2018-03-11T10:47:44","modified_gmt":"2018-03-11T10:47:44","slug":"nuevos-metodos-para-predecir-la-gravedad-y-el-pronostico-de-la-estenosis-aortica-calcificada-asintomatica","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cardiologia\/nuevos-metodos-para-predecir-la-gravedad-y-el-pronostico-de-la-estenosis-aortica-calcificada-asintomatica\/","title":{"rendered":"Nuevos m\u00e9todos para predecir la gravedad y el pron\u00f3stico de la estenosis a\u00f3rtica calcificada asintom\u00e1tica"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Miryam Martinez Pascual Del Riquelme <\/strong><\/h2>\n<p>Resumen introducci\u00f3n. Aunque la ecocardiograf\u00eda es la t\u00e9cnica de elecci\u00f3n para evaluar el grado de severidad de la estenosis a\u00f3rtica, en determinados pacientes tiene sus limitaciones. De ah\u00ed surge el inter\u00e9s por determinar otros par\u00e1metros, como el fragmento terminal del p\u00e9ptido natriur\u00e9tico tipo b (nt-probnp) y la calcificaci\u00f3n valvular a\u00f3rtica, que se relacionen de forma adecuada con la severidad de la estenosis. En relaci\u00f3n al pron\u00f3stico de los pacientes con estenosis a\u00f3rtica grave, \u00e9ste es excelente mientras los pacientes permanecen asintom\u00e1ticos. Sin embargo, empeora de forma significativa una vez que los s\u00edntomas aparecen. Como no siempre es posible una r\u00e1pida asistencia al paciente que desarrolla s\u00edntomas, predecir qu\u00e9 pacientes asintom\u00e1ticos con estenosis a\u00f3rtica moderada-grave tienen un mayor riesgo de evoluci\u00f3n adversa, es objeto permanente de investigaci\u00f3n.  por lo tanto, los objetivos del presente estudio fueron analizar la relaci\u00f3n existente entre los niveles de nt-probnp y de calcificaci\u00f3n valvular a\u00f3rtica, y los par\u00e1metros ecocardiogr\u00e1ficos de severidad de la estenosis en pacientes con estenosis a\u00f3rtica calcificada moderada-grave asintom\u00e1tica; determinar el pron\u00f3stico a 24 meses de seguimiento de los pacientes asintom\u00e1ticos con estenosis a\u00f3rtica moderada-grave, en su actual contexto epidemiol\u00f3gico; y evaluar el valor pron\u00f3stico de par\u00e1metros cl\u00ednicos, ecocardiogr\u00e1ficos, electrocardiogr\u00e1ficos, anal\u00edticos, y de calcificaci\u00f3n valvular a\u00f3rtica a 24 meses de seguimiento en estos pacientes.  m\u00e9todo. Se realiz\u00f3 un estudio de cohortes prospectivo unic\u00e9ntrico en el que se reclutaron durante un per\u00edodo de dos a\u00f1os todos los pacientes valorados mediante ecocardiograf\u00eda-doppler en la unidad de evaluaci\u00f3n no invasiva del complejo hospitalario universitario de cartagena, en los que se observ\u00f3 la existencia de una estenosis a\u00f3rtica calcificada moderada-grave asintom\u00e1tica (velocidad pico de flujo a nivel de la v\u00e1lvula a\u00f3rtica (vmax ao) ? 3,5 m\/s). Los pacientes fueron sometidos a un seguimiento cl\u00ednico durante 24 meses, en el que se valor\u00f3 la aparici\u00f3n de eventos adversos, consider\u00e1ndose tales la indicaci\u00f3n de reemplazo valvular a\u00f3rtico (rva) por aparici\u00f3n de s\u00edntomas o la muerte card\u00edaca.  resultados y conclusiones. Se reclutaron 63 pacientes, en los que en el 30,2% se indic\u00f3 cirug\u00eda de rva por aparici\u00f3n de s\u00edntomas, no hubo ninguna muerte card\u00edaca durante el seguimiento, el 6,3% fallecieron por causa no card\u00edaca y el 1,6% de pacientes se intervino de cirug\u00eda valvular a\u00f3rtica de forma electiva. Los pacientes restantes completaron el seguimiento, no alcanzando ning\u00fan evento de inter\u00e9s. Los niveles de nt-probnp y de calcificaci\u00f3n valvular a\u00f3rtica se presentan como una herramienta modesta en la evaluaci\u00f3n del grado de severidad de la estenosis a\u00f3rtica moderada-grave asintom\u00e1tica. Un punto de corte de calcificaci\u00f3n valvular a\u00f3rtica de 3148 unidades arbitrarias presenta una sensibilidad del 52%, una especificidad del 100%, un valor predictivo positivo del 100% y un valor predictivo negativo del 33%, para el diagn\u00f3stico de severidad de la estenosis a\u00f3rtica. Los an\u00e1lisis de supervivencia univariados mostraron que una vmax ao ? 4,4 m\/s, un ?Pmed &lt; 50 mmhg, un imv &lt; 170 g\/m2, la ausencia de criterios electrocardiogr\u00e1ficos de hipertrofia ventricular izquierda de romhilt y estes, y un valor de nt-probnp ? 700 pg\/ml en el momento del reclutamiento, se asociaron a una mayor supervivencia libre de eventos adversos durante el seguimiento. El an\u00e1lisis multivariado mostr\u00f3 que la presencia de vmax ao &gt; 4,4 m\/s, \u00edndice de comorbilidad de charlson &gt; 1 y nt-probnp &gt; 700 pg\/ml en el momento del reclutamiento fueron predictores independientes de eventos adversos a los 24 meses de seguimiento.   palabras clave: estenosis a\u00f3rtica asintom\u00e1tica, moderada-grave, pron\u00f3stico, supervivencia, calcificaci\u00f3n valvular a\u00f3rtica, nt-probnp.                abstract introduction. Although echocardiography is the gold standard technique to evaluate the severity or aortic stenosis, it presents limitations in some patients. Hence the interest to determine other parameters such as n-terminal fragment of b-type natriuretic peptide (nt-probnp) and aortic valve calcification, that relate appropriately to the severity of the stenosis. Regarding the prognosis of patients with severe aortic stenosis, it is excellent while patients remain asymptomatic. However, it gets worse significantly once symptoms appear. Quick assistance is not always possible for patients who develop symptoms. Therefore, predicting which asymptomatic patients with moderate to severe aortic stenosis have a higher risk of adverse outcomes is permanently under investigation.  therefore, the aims of the present study were: to analyze the relationship between levels of nt-probnp and levels of aortic valve calcification, and echocardiographic parameters of severity in asymptomatic patients with calcific moderate to severe aortic stenosis; to determine the prognosis within 24 months of follow-up of asymptomatic patients with moderate to severe aortic stenosis, in the current epidemiological context; and to evaluate the prognostic value of clinical, echocardiographic, analytical and aortic valve calcification parameters within 24 months of follow-up in these patients.  method. A single-center prospective cohort study was performed. During two years, all asymptomatic patients with moderate to severe calcific aortic stenosis (peak aortic-jet velocity (vmax ao) ? 3,5 m\/s), assessed by doppler echocardiography, were recruited. Patients underwent clinical follow-up for 24 months. Predefined end points for assessing outcome were the occurrence within 24 months of cardiac death or aortic valve replacement necessitated by symptoms.  results and conclusions. 63 patients were recruited: 30,2% of them underwent aortic valve replacement due to symptoms, there was no cardiac death during follow-up, 6,3% died of non-cardiac causes, and 1,6% patients underwent elective aortic valve replacement. The remaining patients completed the follow-up, not reaching any event of interest. Levels of nt-probnp and aortic valve calcification are modest tools to assess the severity of moderate-severe asymptomatic aortic stenosis. A threshold of 3148 arbitrary units provided 52% sensitivity, 100% specificity, 100% positive-predictive value and 33% negative-predictive value for the diagnosis of aortic valve stenosis. Univariate analysis showed that vmax ao ? 4,4 m\/s, transaortic mean pressure gradient &lt;50 mmhg, left ventricular mass index &lt; 170 g\/m2, the absence of romhilt-estes criteria for left ventricular hypertrophy, and level of nt-probnp ? 700 pg\/ml at baseline, were associated with greater adverse event-free survival during the follow-up. According to multivariable analysis: vmax ao &gt; 4,4 m\/s, charlson comorbidity index &gt; 1, and nt-probnp &gt; 700 pg\/ml at baseline, were independent predictors of outcome.  key words: asymptomatic aortic stenosis, moderate-severe, outcome, survival, aortic valve calcification, nt-probnp.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Nuevos m\u00e9todos para predecir la gravedad y el pron\u00f3stico de la estenosis a\u00f3rtica calcificada asintom\u00e1tica<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Nuevos m\u00e9todos para predecir la gravedad y el pron\u00f3stico de la estenosis a\u00f3rtica calcificada asintom\u00e1tica <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Miryam Martinez Pascual Del Riquelme <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 28\/07\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Juli\u00e1n Jes\u00fas Arense Gonzalo<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: federico Soria arcos <\/li>\n<li>fermin Martinez garcia (vocal)<\/li>\n<li>  (vocal)<\/li>\n<li>  (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Miryam Martinez Pascual Del Riquelme Resumen introducci\u00f3n. Aunque la ecocardiograf\u00eda es la t\u00e9cnica de elecci\u00f3n para evaluar [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[932,8235],"tags":[32369,232174,224742,232173],"class_list":["post-117978","post","type-post","status-publish","format-standard","hentry","category-cardiologia","category-murcia","tag-federico-soria-arcos","tag-fermin-Martinez-garcia","tag-julian-jesus-arense-gonzalo","tag-miryam-Martinez-pascual-del-riquelme"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117978","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=117978"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117978\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=117978"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=117978"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=117978"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}