Novas tendências no diagnóstico, terapêutica e prognóstico da insuficiência cardíaca aguda
Palavras-chave:
Insuficiência cardíaca, péptidos natriuréticos, ultrafiltração, nesiritide, levosimendan, antagonistas da hormona anti-diurética, antagonistas da adenosina, troponinas, prateína ST2Resumo
A insuficiência cardíaca aguda é uma síndrome que tem um
significado epidemiológico cada vez maior a nível mundial.
A correcta abordagem desta entidade implica um diagnóstico
célere e uma terapêutica bem estruturada. A utilização do doseamento dos péptidos natriuréticos na prática clínica possibilita
um diagnóstico e uma introdução da terapêutica mais precoces
e, consequentemente, melhor prognóstico. A nível terapêutico
a evolução não é tão significativa. Com efeito, os diuréticos de
ansa e os vasodilatadores permanecem como a melhor opção
terapêutica nestes doentes. Quanto aos últimos fármacos introduzidos na prática clínica, a utilização de levosimendan e
nesiritide está condicionada pelas dúvidas relativamente ao
seu perfil de segurança, enquanto que o tolvaptan demonstrou
uma utilidade limitada. Melhores resultados foram conseguidos
com a introdução da ultrafiltração e de unidades de tratamento
especializadas, embora, por imperativos de ordem prática, a sua utilização seja restrita.
A doença tem um prognóstico sombrio. Na tentativa de estratificar o risco de complicações nestes doentes e identificar
aqueles que podem beneficiar de uma abordagem terapêutica
mais agressiva, foram estudados diversos factores de ordem clínica, destacando-se a função renal, e diversos biomarcadores (os
péptidos natriuréticos, a proteína ST2, as troponinas e a galectina).
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Referências
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