¿CORONARIOGRAFÍA PARA TODOS LOS PACIENTES CON

IC?Dr. Francisco José Torres Calvo

Hospital Costa del Sol

Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Societyof Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200.

Diagnostic algorithm for a diagnosis of heart failure of non-acuteonset. BNP = B-type natriuretic peptide; CAD = coronary arterydisease; HF = heart failure; MI = myocardial infarction; NT-proBNP = N-terminal pro-B type natriuretic peptide. a Patient reportingsymptoms typical of HF. b Normal ventricular and atrial volumesand function. c Consider other causes of elevated natriureticpeptides

Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200.

AHF = acute heart failure; CAD = coronary artery disease; CMR =cardiac magnetic resonance; CRT = cardiac resynchronization therapy;CT = computed tomography; HF = heart failure; HFpEF = heart failurewith preserved ejection fraction; HFmrEF = heart failure with mid-range ejection fraction; HFrEF = heart failure with reduced ejectionfraction; ICD = implantable cardioverter-defibrillator; LGE = lategadolinium enhancement; LVEF = left ventricular ejection fraction; PET= positron emission tomography; SPECT = single-photon emissioncomputed tomography; TTE = transthoracic echocardiography. a Classof recommendation. bLevel of evidence. cReference(s) supportingrecommendations.

Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200.

AHF = acute heart failure; CAD = coronary artery disease; CMR =cardiac magnetic resonance; CRT = cardiac resynchronization therapy;CT = computed tomography; HF = heart failure; HFpEF = heart failurewith preserved ejection fraction; HFmrEF = heart failure with mid-range ejection fraction; HFrEF = heart failure with reduced ejectionfraction; ICD = implantable cardioverter-defibrillator; LGE = lategadolinium enhancement; LVEF = left ventricular ejection fraction; PET= positron emission tomography; SPECT = single-photon emissioncomputed tomography; TTE = transthoracic echocardiography. a Classof recommendation. bLevel of evidence. cReference(s) supportingrecommendations.

Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special

contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200.

Initial management of a patient with acute heartfailure. aAcute mechanical cause: myocardial rupturecomplicating acute coronary syndrome (free wallrupture, ventricular septal defect, acute mitralregurgitation), chest trauma or cardiac intervention,acute native or prosthetic valve incompetencesecondary to endocarditis, aortic dissection orthrombosis, see above.

Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special

contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200.

ACS = acute coronary syndrome; CCU = coronarycare unit; ECG = electrocardiogram; IABP = intra-aortic balloon pump; ICU = intensive care unit; SBP¼= systolic blood pressure. a Class ofrecommendation. b Level of evidence. cReference(s) supporting recommendations.

Assomull RG, et al. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation. 2011 Sep 20;124(12):1351-60.

Late gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) and associated coronary angiogram (CA) images of diagnosis subtypes. Six different diagnoses are graphically represented with LGE-CMR images followed by CA images of the left coronary artery and rightcoronary artery. A, True dilated cardiomyopathy (DCM) shows an LGE-CMR image with no subendocardial LGE and unobstructed coronary arteries on CA. B, True coronary artery disease (CAD) with a circumflex territory infarct on CMR (arrows) and a severe proximal circumflex arterystenosis (arrows). C, A small area of subendocardial LGE (arrows) is seen in a severely dilated left ventricle with severe global systolic impairment and unobstructed coronary arteries representing DCM with bystander infarct. D, Distal disease of the left anterior descending artery(arrows) with no evidence of subendocardial LGE (DCM with bystander CAD). E, A large apical infarct is seen on LGE-CMR in the context of unobstructed coronary arteries suggesting ischemic heart failure (HF) with unobstructed coronary arteries. F, A possible scenario of ischemicheart failure without infarction. There is no LGE on CMR but there is severe proximal 3-vessel disease, including left main stem disease, on CA (arrows). No patient in our study had this scenario; therefore, the images are for illustration only

Judith S. Hochman en la American Heart Association Annual Scientific Sessions (AHA 2019), Philadelphia, PA, November 16, 2019.Presented by John A. Spertus en la American Heart Association Annual Scientific Sessions (AHA 2019), Philadelphia, PA, November 16, 2019 (quality of life outcomes).

AMERICAN COLLEGE ofCARDIOLOGY

CONCLUSIONES

Francisco José Torres Calvo. Unidad de Insuficiencia Cardiaca. Hospital Costa del Sol.

En pacientes que debutan con insuficiencia cardiaca y disfunción ventricular fuera del escenario de un SCA o shock cardiogénico, la coronariografía no está indicada en la fase inicial del manejo de dichos pacientes.

Incluso en pacientes con enfermedad coronaria documentada o probable, la documentación de isquemia significativa y/o viabilidad es prioritaria.

Actualmente, la cardiorresonancia es la prueba que mejor define el diagnóstico,pronóstico y actitud de los pacientes con insuficiencia cardiaca y función sistólica deprimida.