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Estudio fisiológico invasivo para evaluar lesiones coronarias
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Introducción: La revascularización mediante intervención coronaria percutánea con colocación de stent, o cirugía de derivación coronaria, alivia la isquemia miocárdica. Sin embargo, las pruebas de estrés no invasivas y la angiografía coronaria no siempre proporcionan la información adecuada sobre la importancia funcional de las estenosis en las arterias coronarias.
Objetivo: Describir las recomendaciones actuales de la literatura médica con respecto a la fisiología coronaria en la cardiopatía isquémica.
Desarrollo: El índice de reserva fraccional de flujo se considera el estándar de oro para detectar la isquemia miocárdica. Su naturaleza invasiva se equilibra con la resolución espacial inigualable y su relación lineal con el flujo sanguíneo máximo. Los resultados clínicos de pacientes cuya estrategia de revascularización se basa en mediciones de reserva fraccional de flujo son decisivos en varios subconjuntos de diferentes lesiones. En la última década se ha propuesto la evaluación de la gravedad de la estenosis coronaria mediante índices no hiperémicos. Sin embargo, la precisión de estos índices para distinguir correctamente la isquemia miocárdica es solo del 80 %.
Conclusiones: Actualmente, la hiperemia máxima se recomienda para una óptima toma de decisiones sobre la revascularización.
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Referencias
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