Avaliação e estratificação da cardiomiopatia hipertrófica quanto ao risco de morte súbita: uma revisão integrativa
Evaluation and stratification of hypertrophic cardiomyopathy as to the risk of sudden death: an integrative review
DOI:
https://doi.org/10.34119/bjhrv5n6-133Keywords:
cardiomiopatia hipertrófica, morte súbita, fatores de risco, morte súbita cardíacaAbstract
Introdução: A cardiomiopatia hipertrófica (CMH) é uma condição genética autosômica-dominante, mais comumente causada por mutações de genes sarcoméricos, caracterizada pela hipertrofia miocárdica ventricular esquerda (HVE) de várias morfologias, com ampla gama de manifestações clínicas e alterações hemodinâmicas. É a causa mais frequente de morte súbita cardíaca (MSC) em jovens e atletas competitivos devido a arritmia ventricular fatal. Em alguns pacientes, entretanto, a CMH pode ter curso benigno. Objetivo: Identificar e analisar os fatores de risco de morte súbita associados à cardiomiopatia hipertrófica. Método: Foi realizada revisão integrativa a fim de estratificar e avaliar a história natural da cardiomiopatia hipertrófica em relação aos fatores de risco de morte súbita. Extraídos artigos científicos publicados no período de 2000 a 2022, das bases de dados – Medical Literature Analysis and Retrieval System online (MEDLINE/Pubmed), Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (Scielo) – utilizando-se do vocabulário livre e controlado indexados nos Descritores em Ciências de Saúde (DeCS) – Cardiomiopatia hipertrófica, morte súbita, fatores de risco, morte súbita cardíaca. Foram selecionados estudos observacionais da língua inglesa. A presente revisão integrativa incluiu 23 artigos. Inicialmente encontrados 874 estudos, que passaram por uma seleção através da leitura de títulos, seguida pela exclusão de duplicação de trabalho, conseguinte de avaliação do resumo e, por fim, a análise dos artigos na íntegra, garantindo assim sua qualidade. Resultados: Os fatores de risco associados a morte súbita (MS) na cardiomiopatia hipertrófica foram: história pessoal de fibrilação ventricular (FV), MSC ou taquicardia ventricular (TV) sustentada; história familiar de MSC; síncope prévia inexplicada; taquicardia ventricular não sustentada (TVNS); espessura máxima da parede do ventrículo esquerdo de ≥30mm e resposta anormal da pressão arterial durante o exercício. As evidências demonstraram a relevância de acrescentar ao algoritmo de seleção dos pacientes: a disfunção sistólica do VE, aneurisma apical de VE e o realce tardio extenso (RTG) na ressonância magnética cardíaca. Conclusão: A estratificação de risco para MSC na CMH apresentou ampliação dos preditores. Existe a necessidade contínua de pesquisas em torno do tema para a instituição de medidas terapêuticas a fim de evitar desfechos fatais da doença
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