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Hipertrofia del ventrículo izquierdo, fibrosis cardiaca y disfunción diastólica en la enfermedad renal crónica
Resumen
Las enfermedades cardiovasculares se presentan del 75 al 80% como causas de morbimortalidad en pacientes con enfermedad renal crónica. En estudios epidemiológicos, las causas más frecuentes de muerte cardiovascular son: muerte súbita, arritmias, falla cardiaca, enfermedad arterial coronaria e infarto del miocardio. La insuficiencia cardiaca y las arritmias cardiacas son causadas por la hipertrofia del ventrículo izquierdo y la fibrosis cardiaca.
Los factores fisiopatológicos involucrados en la hipertrofia del ventrículo izquierdo se dividen en 3 categorías: relacionado a la poscarga, relacionado a la precarga y los no relacionados ni a la poscarga, ni a la precarga.
La hipertrofia miocárdica induce la activación de señales de apoptosis celular y activa las vías metabólicas capaces de aumentar la producción de matriz extracelular hasta fibrosis. La fibrosis conduce al deterioro progresivo de la contractilidad y al engrosamiento de la pared del miocardio, causando disfunción diastólica, sistólica y miocardiopatía dilatada con insuficiencia cardiaca congestiva. El objetivo de esta revisión es conocer la fisiopatología de la hipertrofia del ventrículo izquierdo, de la fibrosis cardiaca y de la disfunción diastólica en la enfermedad renal crónica.
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