Associação da função endotelial microvascular sistêmica com vasorreatividade pulmonar em pacientes candidatos ao transplante cardíaco
Associação da função endotelial microvascular sistêmica com vasorreatividade pulmonar em pacientes candidatos ao transplante cardíaco
Data
2025
Autores
Fatorelli, Antonio Feliciano
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A insuficiência cardíaca (IC) é uma síndrome clínica complexa caracterizada por comprometimento estrutural ou funcional do enchimento ventricular ou da ejeção. A disfunção endotelial (DE) em nível microcirculatório desempenha papel fundamental no desenvolvimento e progressão das doenças cardiovasculares, incluindo a IC. O transplante cardíaco (TC) é uma modalidade terapêutica considerada para IC avançada e refratária. Objetivos: Este estudo investigou a associação entre a reatividade microvascular sistêmica, medida não invasivamente por meio de imagem de contraste por laser speckle (LSCI), e a hemodinâmica pulmonar em pacientes com IC avançada em avaliação para TC. Método: Estudo observacional, transversal e prospectivo, conduzido com 30 pacientes com IC avançada submetidos ao teste de vasorreatividade pulmonar. A função microvascular foi avaliada por LSCI com micro-iontoforese de acetilcolina (ACh) e nitroprussiato de sódio (NPS). As variáveis hemodinâmicas foram obtidas por cateterismo cardíaco direito. Foram aplicados testes de correlação linear de Pearson. Resultados: Observou-se correlação inversa significativa entre a resposta à ACh e a resistência vascular sistêmica indexada (RVSi) (r = -0,39; p = 0,03) e resistência vascular pulmonar indexada (RVPi) (r = -0,48; p = 0,009). A resposta ao NPS também se correlacionou negativamente com a RVSi (r = -0,48; p = 0,008) e RVPi (r = -0,43; p = 0,01). Adicionalmente, a PSAP correlacionou-se positivamente com a resposta ao NPS (r = 0,43; p = 0,01), indicando relação entre tônus vasomotor periférico e hipertensão pulmonar. Conclusões: A disfunção microvascular sistêmica demonstrou associação significativa com parâmetros hemodinâmicos pulmonares e sistêmicos em pacientes com IC avançada. Estes achados sugerem que a avaliação da microcirculação, por método não invasivo, pode ser uma ferramenta complementar na estratificação hemodinâmica e no manejo clínico de candidatos ao TC. Estudos futuros poderão validar seu papel como marcador prognóstico e orientar intervenções terapêuticas direcionadas à função endotelial.
Introduction: Heart failure (HF) is a complex clinical syndrome characterized by structural or functional impairment of ventricular filling or ejection. Endothelial dysfunction (ED) at the microcirculatory level plays a key role in the development and progression of cardiovascular diseases, including HF. Heart transplantation (HT) is a therapeutic modality considered for advanced and refractory HF. Objectives: This study investigated the association between systemic microvascular reactivity, non-invasively assessed by laser speckle contrast imaging (LSCI), and pulmonary hemodynamics in patients with advanced HF undergoing evaluation for HT. Method: This was an observational, cross-sectional, and prospective study including 30 patients with advanced HF who underwent pulmonary vasoreactivity testing. Microvascular function was assessed by LSCI combined with micro-iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). Hemodynamic parameters were obtained through right heart catheterization. Pearson linear correlation tests were applied. Results: A significant inverse correlation was observed between ACh response and systemic vascular resistance index (SVRi) (r = -0.39; p = 0.03) and pulmonary vascular resistance index (PVRi) (r = -0.48; p = 0.009). The response to SNP also showed a negative correlation with SVRi (r = -0.48; p = 0.008) and PVRi (r = -0.43; p = 0.01). Additionally, pulmonary artery systolic pressure (PASP) was positively correlated with the SNP response (r = 0.43; p = 0.01), indicating a relationship between peripheral vasomotor tone and pulmonary hypertension. Conclusions: Systemic microvascular dysfunction showed a significant association with pulmonary and systemic hemodynamic parameters in patients with advanced HF. These findings suggest that non-invasive microcirculation assessment may serve as a complementary tool for hemodynamic stratification and clinical management of candidates for HT. Future studies may validate its role as a prognostic marker and guide therapeutic interventions targeting endothelial function.
Introduction: Heart failure (HF) is a complex clinical syndrome characterized by structural or functional impairment of ventricular filling or ejection. Endothelial dysfunction (ED) at the microcirculatory level plays a key role in the development and progression of cardiovascular diseases, including HF. Heart transplantation (HT) is a therapeutic modality considered for advanced and refractory HF. Objectives: This study investigated the association between systemic microvascular reactivity, non-invasively assessed by laser speckle contrast imaging (LSCI), and pulmonary hemodynamics in patients with advanced HF undergoing evaluation for HT. Method: This was an observational, cross-sectional, and prospective study including 30 patients with advanced HF who underwent pulmonary vasoreactivity testing. Microvascular function was assessed by LSCI combined with micro-iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). Hemodynamic parameters were obtained through right heart catheterization. Pearson linear correlation tests were applied. Results: A significant inverse correlation was observed between ACh response and systemic vascular resistance index (SVRi) (r = -0.39; p = 0.03) and pulmonary vascular resistance index (PVRi) (r = -0.48; p = 0.009). The response to SNP also showed a negative correlation with SVRi (r = -0.48; p = 0.008) and PVRi (r = -0.43; p = 0.01). Additionally, pulmonary artery systolic pressure (PASP) was positively correlated with the SNP response (r = 0.43; p = 0.01), indicating a relationship between peripheral vasomotor tone and pulmonary hypertension. Conclusions: Systemic microvascular dysfunction showed a significant association with pulmonary and systemic hemodynamic parameters in patients with advanced HF. These findings suggest that non-invasive microcirculation assessment may serve as a complementary tool for hemodynamic stratification and clinical management of candidates for HT. Future studies may validate its role as a prognostic marker and guide therapeutic interventions targeting endothelial function.
Description
Palavras-chave
Insuficiência cardíaca, Microcirculação, Hipertensão pulmonar, Transplante cardíaco, Heart failure, Microcirculation, Pulmonary hypertension, Heart transplantation.
Citação
Fatorelli AF. Associação da função endotelial microvascular sistêmica com vasorreatividade pulmonar em pacientes candidatos ao transplante cardíaco. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia - INC; 2025.