Valoración del riesgo quirúrgico del paciente con cardiopatía

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Valoración del riesgo quirúrgico 
del paciente con cardiopatía
Las complicaciones cardiovasculares perioperatorias (CCP) que pueden 
aparecer en un cardiópata sometido a una intervención quirúrgica 
no cardíaca (IQNC) se relacionan con su estado de salud previo, sus 
comorbilidades y su medicación, y la intervención. Las CCP se estra-
tifican en grado I, cualquier alteración en el postoperatorio normal; 
grado II, aquellas que necesitan tratamiento específico; grado III, las 
que precisan una intervención quirúrgica; grado IV, complicación 
potencialmente mortal, y grado V, alteración que produce la muerte.
VALORACIÓN DEL RIESGO QUIRÚRGICO 
CARDIOVASCULAR
Estado previo del paciente
La mayor edad y los antecedentes de insuficiencia cardíaca, enfermedad 
cerebrovascular y cardiopatía orgánica aumentan los riesgos de CCP. 
Las cardiopatías activas que requieren evaluación y tratamiento son los 
síndromes coronarios inestables, el infarto de miocardio reciente, la 
insuficiencia cardíaca descompensada, las arritmias graves y la estenosis 
aórtica o mitral y la insuficiencia mitral graves.
Comorbilidades
Debe tenerse en cuenta la presencia de enfermedades concomitantes, 
como obesidad, diabetes mellitus insulinodependiente, enfermedad 
pulmonar obstructiva crónica, cáncer, insuficiencia renal grave, hepa-
topatías, demencia y fragilidad.
Magnitud, tipo y duración 
de la intervención quirúrgica
El riesgo de padecer CCP depende del tipo de intervención quirúrgica. 
Son de bajo riesgo (< 1%) de muerte o infarto de miocardio (IM) las 
cirugías endocrinas, mamarias y oftalmológicas, así como las de tipo 
menor ginecológicas, ortopédicas o urológicas, las plásticas y odonto-
lógicas, y los procedimientos endoscópicos digestivos. Son de riesgo 
intermedio (1%-5%) las intervenciones abdominales (excepto si es 
general mayor), de cabeza y cuello, así como las mayores ginecológicas, 
ortopédicas o urológicas, la endarterectomía carotídea, las angioplas-
tias periféricas y los procedimientos endoscópicos terapéuticos. Son 
de alto riesgo (>5%) las intervenciones aórticas (ya sean quirúrgicas 
o reparaciones endovasculares), las vasculares periféricas y las mayores
generales, torácicas, vasculares o neuroquirúrgicas.
Condiciones en las que se realiza 
la intervención quirúrgica
Las intervenciones de urgencia (entre 24 y 72 h después del proceso 
agudo) y, especialmente, las de emergencia (dentro de las 24 h pos-
teriores al proceso agudo) se asocian con un incremento de CCP.
DETERMINACIÓN DE LA CAPACIDAD 
FUNCIONAL
Se considera que una capacidad funcional igual o superior a 4 MET 
(1 MET = tasa metabólica basal) garantiza un pronóstico postopera-
torio bueno. La capacidad funcional puede estimarse por la anamnesis 
o ergometría.
ESTIMACIÓN DEL RIESGO 
CARDIOVASCULAR
El riesgo cardiovascular no depende de una sola variable, siendo impres-
cindible emplear modelos multivariables. La puntuación de Lee tiene 
en cuenta los antecedentes de enfermedad coronaria, enfermedad 
cerebrovascular, insuficiencia cardíaca, diabetes mellitus insulinode-
pendiente, insuficiencia renal e intervención quirúrgica de alto riesgo. 
Se puede calcular la puntuación de Lee en https://qxmd.com/calculate/
calculator_195/revised-cardiac-risk-index-lee-criteria.
BIOMARCADORES CARDÍACOS, 
PRUEBAS NO INVASIVAS 
Y CINECORONARIOGRAFÍA PREOPERATORIA
La indicación de estos estudios está determinada por el marco de 
referencia de cada paciente. No se recomienda la medición sistemática 
de biomarcadores cardíacos. La cinecoronariografía preoperatoria está 
recomendada solamente en el paciente con un IM con elevación del 
segmento ST en curso, angina inestable o resistencia al tratamiento 
farmacológico.
ESTRATEGIAS PARA REDUCIR EL RIESGO 
CARDIOVASCULAR PERIOPERATORIO
Es indispensable optimizar el tratamiento farmacológico de la 
cardiopatía subyacente. Además, debe considerarse la posibilidad 
de mantener todos los medicamentos activos consumidos habi-
tualmente. Está indicado el uso de β-bloqueantes (iniciar el tra-
tamiento entre 30 días y un mínimo de 2 días antes de la cirugía 
y continuar en el postoperatorio con un objetivo de frecuencia 
cardíaca de 60-70 latidos/min y PAS > 100 mm Hg) en pacientes 
con cardiopatía isquémica, insuficiencia cardíaca con disfunción 
sistólica y previamente medicados con estos fármacos por arritmias 
o hipertensión arterial. Los que necesitan una IQNC electiva y
consumen dos antiagregantes plaquetarios (AAS más clopidogrel,
prasugrel o ticagrelor) por una revascularización miocárdica percu-
tánea deben operarse con mantenimiento sólo del AAS. Además,
la IQNC ha de postergarse al menos 14 días, 6 semanas o 1 año
si se realizó una angioplastia con balón, con stent no recubierto
o con stent farmacoactivo, respectivamente. La revascularización
miocárdica profiláctica, quirúrgica o percutánea antes de una IQNC
está recomendada en el paciente con una coronariopatía grave que
debe ser sometido a una cirugía de alto riesgo.
ENFERMEDADES ESPECÍFICAS
Los pacientes con insuficiencia cardíaca, hipertensión arterial, valvu-
lopatías, prótesis valvulares, arritmias cardíacas, hipertensión arterial 
pulmonar, enfermedad cerebrovascular, enfermedad renal crónica, 
enfermedad pulmonar obstructiva crónica, necesitan evaluación y 
tratamiento específico de estas condiciones.
https://booksmedicos.org
573 CAPÍTULO 64 Valoración del riesgo quirúrgico del paciente con cardiopatía
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 Evaluación preoperatoria del riesgo cardíaco y el manejo perioperatorio. Siempre que sea posible, se debe iniciar el tratamiento 
entre 30 días y un mínimo de 2 días antes de la cirugía y continuar en el postoperatorio con un objetivo de frecuencia cardíaca de 60-70 latidos/
min y presión arterial sistólica > 100 mm Hg. AAS: ácido acetilsalicílico; CABG: cirugía de revascularización coronaria; ICP: intervención coronaria 
percutánea; IECA: inhibidores de la enzima convertidora de la angiotensina; IQ: intervención quirúrgica; MET: equivalentes metabólicos; VI: ven-
trículo izquierdo. (Tomado de Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. 
Eur Heart J 2014;35:2383-431. © 2014 Oxford University Press.)
Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en junio 11, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.
https://booksmedicos.org
574 SECCIÓN II I Cardiología
ANESTESIA Y CONTROLES 
PERIOPERATORIOS
Las condiciones clínicas de cada paciente pueden determinar la nece-
sidad de utilizar diferentes estrategias anestésicas y realizar controles 
perioperatorios con electrocardiograma, ecocardiografía bidimensional 
o transesofágica, glucemia y control adecuado del dolor.
En la figura 64-1 se presenta el algoritmo recomendado en 2014 por
la European Society of Cardiology (ESC) para identificar a los pacientes 
que se benefician de una evaluación y un tratamiento cardiovascular, 
incluida la revascularización miocárdica, en el preoperatorio de una 
IQNC.
BIBLIOGRAFÍA ESPECIAL
Cohn SL. Preoperative Evaluation for Noncardiac Surgery. Ann Intern Med 
2016;165:ITC81-96. 
De Hert S, Staender S, Fritsch G, Hinkelbein J, Afshari A, Bettelli G, et al. 
Pre-operative evaluation of adults undergoing elective noncardiac surgery: 
Updated guideline from the European Society of Anaesthesiology. Eur J 
Anaesthesiol 2018;35:407-65. 
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, 
Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular 
evaluation and management of patients undergoing noncardiac surgery: a 
report of the American College of Cardiology/American Heart Association 
Task Force on practice guidelines. J Am Coll Cardiol 2014;64:e77-e137. 
Krauss J, Botto F, Lucas L, Bagnatti R. Consenso argentino deevaluación 
de riesgo cardiovascular en cirugía no cardíaca. Rev Argent Cardiol 
2016;84(Supl. 1):1-38. 
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al. 
2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular asses-
sment and management: The Joint Task Force on non-cardiac surgery: 
cardiovascular assessment and management of the European Society of 
Cardiology (ESC) and the European Society of Anaesthesiology (ESA). 
Eur Heart J 2014;35:2383-431. 
BIBLIOGRAFÍA GENERAL
Abbara S, Walker TG. Diagnostic Imaging: Cardiovascular. Salt Lake City: 
AmirsysInc; 2008. 
Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. 
U.S. CoreValve Clinical Investigators. Transcatheter aortic-valve repla-
cement with a self-expanding prosthesis. N Engl J Med 2014;370(19): 
1790-8. 
Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, 
Task Force Members 2015. et al. ESC Guidelines for the diagnosis and 
management of pericardial diseases. The Task Force for the Diagnosis 
and Management of Pericardial Diseases of the European Society of Cardio-
logy (ESC). Endorsed by: The European Association for Cardio-Thoracic 
Surgery (EATCS). Eur Heart J 2015;36:2921-64. 
Almirante B, Tornos P. Actualización en endocarditis infecciosa. Barcelona: 
Marge Books; 2011. 
Arnett DK, Blumnethal RS, Albert MA, Buroker AB, Goldberger ZA, Hahn 
EJ, et al. 2019 ACC/AHA Guidelines on Primary Prevention of Cardiovas-
cular Disease: A Report of the American College of Cardiology/American 
Heart Association Task Force on Clinical Practice Guidelines. Circulation 
2019;140:e596-646. 
Azocar D, Ruiz Granell R, Ferrero A, Martínez Brotons A, Izquierdo M, 
Domínguez E, et al. Síncope y bloqueo de rama. Rendimiento del uso 
escalonado del estudio electrofisiológico y de la monitorización electrocar-
diográfica prolongada. Rev Esp Cardiol 2011;64:213-9. 
Baddour W, Wilson KA, Bayer M, Fowler PB, Tleyjeh LM, Rybak M, et al. 
Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, 
and Management of Complications: A Scientific Statement for Health-
care Professionals From the American Heart Association. Circulation 
2015;132:1435-754. 
Badimon L, Padro T, Vilahur G. Atherosclerosis, platelets and thrombosis 
in acute ischaemic heart disease. Eur Heart J Acute Cardiovasc Care 
2012;1:60-74. 
Badimon L, Storey RF, Vilahur G. Update on lipids, inflammation and athe-
rothrombosis. Thromb Haemost 2011;105:S34-42. 
Badimon L, Suades R, Arderiu G, Peña E, Chiva-Blanch G, Padró T. Micro-
vesicles in Atherosclerosis and Angiogenesis: From Bench to Bedside and 
Reverse. Front Cardiovasc Med 2017;4:77. 
Badimon L, Vilahur G. Thrombus formation on atherosclerotic lesions and 
plaque rupture. J Intern Med 2014;276:618-32. 
Baena-Díez JM, Félix FJ, Grau M, Cabrera de León A, Sanz H, Leal M, et al. 
Tratamiento y control de los factores de riesgo según el riesgo coronario en la 
población española del estudio DARIOS. Rev Esp Cardiol 2011;64:766-73. 
Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz 
JJ, et al. Relationship between clinic and ambulatory blood-pressure mea-
surements and mortality. N Engl J Med 2018;378:1509-20. 
Baron-Esquivias G, Morillo CA, Moya-Mitjans A, Martinez-Alday J, Ruiz-
Granell R, Lacunza-Ruiz J, et al. Dual-chamber pacing with closed loop 
stimulation in recurrent reflex vasovagal syncope: the SPAIN Study. J Am 
Coll Cardiol 2017;70:1720-8. 
Basso C, Rizzo S, Valente M, Thiene G. Cardiac masses and tumours. Heart 
2016;102:1230-45. 
Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie 
N, et al. Task Force on the Management of Grown-up Congenital Heart 
Disease of the European Society of Cardiology (ESC); Association for 
European Paediatric Cardiology (AEPC); ESC Committee for Practi-
ce Guidelines (CPG). ESC Guidelines for the management of grown-
up congenital heart disease (new version 2010). Eur Heart J 2010;31: 
2915-57. 
Baumgartner H, Falk V, Bax JJ, de Bonis M, Hamm C, Holm PJ, et al. 
2017 ESC/EACTS Guidelines for the management of valvular heart disease. 
European Heart Journal 2017;38:2739-91. 
Becker MAJ, Cornel JH, van de Ven PM, van Rossum AC, Allaart CP, Germans 
T. The Prognostic Value of Late Gadolinium-Enhanced Cardiac Magnetic
Resonance Imaging in Nonischemic Dilated Cardiomyopathy. A Review
and Meta-Analysis. J Am Coll Cardiol Img 2018;11(9):1274-84. 
Benito B, Brugada J, Brugada R, Brugada P. Síndrome de Brugada. Rev Esp 
Cardiol 2009;62(11):1297-315. 
Bosch X, Théroux P. Continuous risk stratification in acute coronary syndro-
mes. En: Théroux P, ed. Acute Coronary Syndromes. A Companion to 
Braunwald’s Heart Disease. New York: Elsevier/Saunders; 2003. p. 322-9. 
Breen JF, Callahan MJ, Lloyd MA. Cardiac Radiography. En: Murphy JG, 
Lloyd MA, eds. Mayo Clinic Cardiology. 4rd ed. Rochester: Mayo Clinic 
Scientific Press; 2013. p. 159-76. 
Brignole M, Menozzi C, Bartoletti A, Giada F, Lagi A, Ungar A, et al. A new 
management of syncope: prospective systematic guideline-based evaluation 
of patients referred urgently to general hospitals. Eur Heart J 2006;27:76-
82. 
Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. The 
Task Force for the Diagnosis and Management of Syncope of the European 
Society of Cardiology (ESC). 2018 ESC Guidelines for the diagnosis and 
management of syncope. European Heart Journal 2018;39(21):1883-948. 
Brugada P, Brugada J. Right bundle branch block, persistent ST segment 
elevation and sudden cardiac death: A distinct clinical and electrocardio-
graphic syndrome. J Am Coll Cardiol 1992;20:1391-6. 
Brugada P, Brugada J, Mont L, Smeets J, Andries EW. New criteria for diffe-
rential diagnosis of VT. Circulation 1991;83:1649-59. 
Calvo N, Arbelo E, Berruezo A, Mont L, Tolosana JM, Brugada J. Manual de 
Electrofisiología clínica y ablación. Barcelona: Marge Medica Books; 2011. 
Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Koos 
BJ, et al. Management of pregnancy in patients with complex congenital 
heart disease: A Scientific Statement for Healthcare Professionals from the 
American Heart Association. Circulation 2017;21(135):e50-87. 
Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-
Himmelfarb CR, et al. Resistant Hypertension: Detection, Evaluation, and 
Management: A Scientific Statement From the American Heart Association. 
Hypertension 2018;72:e53-90. 
Ceska R, Gil-Extremera B, Paolini JF, Giezek H, Vandormael K. Effcacy and 
safety of extended-release niacin/laropiprant plus statin vs. doubling the 
dose of statin in patients with primary hypercholesterolaemia or mixed 
dyslipidaemia. Int J Clin Pract 2010;64:727-38. 
Chen W, Sajadi MM, Dilsizian V. Merits of FDG PET/CT and functional 
molecular imaging over anatomic imaging with Echocardiography and CT 
Angiography for the diagnosis of cardiac device infections. JACC Cardiovasc 
Imaging 2018;11(11):1679-91. 
Cid-Alvarez AB, Rodriguez Leor O, Moreno R, Pérez de Prado A. Registro 
Español de Hemodinámica y Cardiología Intervencionista. XXVII Informe 
Oficial de la Sección de Hemodinámica y Cardiología Intervencionista 
de la Sociedad Española de Cardiología (1990-2017). Rev Esp Cardiol 
2018;71:1036-46. 
Cinca J, Janse MJ, Morena H, Candell J, Valle V, Durrer D. Mechanism and 
time course of the early electrical changes during acute coronary artery 
occlusion. An attempt to correlate the early ECG changes in man to the 
cellular electrophysiology in the pig. Chest 1980;77:499-505. 
Cohn SL. Preoperative Evaluation for Noncardiac Surgery. Ann Intern Med 
2016;165:ITC81-96. 
https://booksmedicos.org
575 CAPÍTULO 64 Valoración del riesgo quirúrgico del paciente con cardiopatía
S
E
C
C
IÓ
N
 I
II
Cosyns B, Plein S, Nihoyanopoulos P, Smiseth O, Achenbach S, Andrade MJ, 
et al. European Association of Cardiovascular Imaging (EACVI) position 
paper: multimodality imaging in pericardial disease. Eur Heart J-CardiovascImaging 2015;16:12-31. 
Cowan JR, Ware SM. Genetics and Genetic Testing in Congenital Heart 
Disease. Clin Perinatol 2015;42:373-93. 
De Hert S, Staender S, Fritsch G, Hinkelbein J, Afshari A, Bettelli G, et al. 
Pre-operative evaluation of adults undergoing elective noncardiac surgery: 
Updated guideline from the European Society of Anaesthesiology. Eur J 
Anaesthesiol 2018;35:407-65. 
De Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Medite-
rranean diet, traditional risk factors and rate of cardiovascular disease after 
myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 
1999;99:779-85. 
Dégano IR, Salomaa V, Veronesi G, Ferrieres J, Kirchberger I, Laks T, Acute 
Myocardial Infarction Trends in Europe (AMITIE) Study Investiga-
tors. et al. Twenty-five-year trends in myocardial infarction attack and 
mortality rates, and case-fatality, in six European populations. Heart 
2015;101:1413-21. 
Di Carli M, Lipton MJ. Cardiac PET and PET/CT Imaging. Boston: Springer; 
2007. 
Elkayam U, Goland S, Pieper PG, Silverside CK. High-risk cardiac disease in 
pregnancy: Part I. J Am Coll Cardiol 2016;68:396-410. 
Elkayam U, Goland S, Pieper PG, Silversides CK. High-risk cardiac disease in 
pregnancy: Part II. J Am Coll Cardiol 2016;68:502-16. 
European Society of Cardiology. Textbook of Cardiovascular Imaging. London: 
Springer-Verlag; 2010. 
Farnier M, Roth E, Gil Extremera B, Mendez GF, MacDonnell G, Hamlin 
C, et al. Effcacy and safety of the coadministration of ezetimibe/simvas-
tatin with fenofibrate in patients with mixed hyperlipidemia. Am Heart J 
2007;153. 335e1-8. 
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, 
Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular 
evaluation and management of patients undergoing noncardiac surgery: a 
report of the American College of Cardiology/American Heart Association 
Task Force on practice guidelines. J Am Coll Cardiol 2014;64:e77-e137. 
García Fernández MA, Zamorano J. Procedimientos en Ecocardiografía. 
Madrid: McGraw-Hill; 2004. 
García Gallego F, Gamallo Amat C, Aguado MG. Registro Nacional de tumores 
(memoria 1996-1997). Rev Esp Cardiol 1999;52:13-20. 
Gil Extremera B, Ivanova Georgieva R, Maldonado Martín A, Gómez Jiménez 
FJ. Hipertensión arterial y factores de riesgo cardiovascular. En: Aranceta 
J, Foz M, Gil Extremera B, Jover E, Mantilla T, Millán J, eds. Obesidad y 
riesgo cardiovascular. Estudio DORICA. Madrid: Editorial Médica Pana-
mericana; 2003. p. 5-15. 
Grau M, Elosúa R, Cabrera de León A, Guembe MJ, Baena-Díez JM, Vega 
Alonso T, et al. Factores de riesgo cardiovascular en España en la primera 
década del siglo XXI: análisis agrupado con datos individuales de 11 estudios 
de base poblacional, estudio DARIOS. Rev Esp Cardiol 2011;64:295-304. 
Grubb BP. Neurocardiogenic syncope. En: Grubb BP, Olhansky B, eds. Synco-
pe: Mechanisms and Management. New York: Futura Publishing; 1998. 
p. 73-106. 
Habib G, Lancellotti B, Antunes P, Bongiorni F, Casalta B, Del Zotti I, et al. 
2015 ESC Guidelines for the management of infective endocarditis: The 
Task Force for the Management of Infective Endocarditis of the European 
Society of Cardiology (ESC). Eur Heart J 2015;36:3075-128. 
Haller H, Ito S, Izzo JL Jr, Januszewicz A, Katayama S, Menne J, ROADMAP 
Trial Investigators. et al. Olmesartan for delay or prevention of microalbu-
minuria in type 2 diabetes. N Engl J Med 2011;364:907-17. 
Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente 
AM. Use of medication for cardiovascular disease during pregnancy: JACC 
State-of-the-Art Review. J Am Coll Cardiol 2019;73:457-76. 
Hare JM. The dilated, restrictive and infiltrative cardiomyopathies. En: Mann 
DL, Zipes DP, Libby P, Bonow RO, eds. Braunwald’s Heart Disease. 10th 
ed. Philadelphia: Saunders/Elsevier; 2015. p. 1739-62. 
Hernáez Á, Zomeño MD, Dégano IR, Pérez-Fernández S, Goday A, Vila J, 
et al. Excess Weight in Spain, Current Situation, Projections for 2030, 
Estimated Direct Extra Cost for the Spanish Health System. Rev Esp 
Cardiol 2018;S1885-5857(18):30440-7. 
Hochman JS, Sleeper LA, Webb JG, Dzavik V, Buller CE, Aylward P, et al. Early 
revascularization and long term survival in cardiogenic shock complicating 
acute myocardial infarction. JAMA 2006;205:2511-8. 
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, 
The Task Force for the management of acute myocardial infarction in 
patients presenting with ST-segment elevation of the European Society of 
Cardiology (ESC). et al. 2017 ESC Guidelines for the management of acute 
myocardial infarction in patients presenting with ST-segment elevation. Eur 
Heart J 2018;39:119-77. 
Iskandrian AE, García EV. Nuclear Cardiac Imaging. Principles and Applica-
tions. New York: Oxford University Press; 2008. 
Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärnwolf C, Levang 
OW, et al. A prospective survey of patients with valvular heart disease in 
Europe: The Euro Heart Survey on Valvular Heart Diseases. Eur Heart J 
2003;24:1231-43. 
Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK. The Diagnosis and Evalua-
tion of Dilated Cardiomyopathy. J Am Coll Cardiol 2016;67:2996-3010. 
Kapadia SR, Leon MB, Makkar RR, Tuzcu EM, Svensson LG, Kodali S, 
PARTNER trial investigators. et al. 5-year outcomes of transcatheter aortic 
valve replacement compared with standard treatment for patients with 
inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. 
Lancet 2015;385:2485-91. 
Kay IP, Sabaté M, Costa MA. Cardiac Catheterization and Percutaneous Inter-
ventions. London: Taylor & Francis Group; 2004. 
Kennedy HL. Use of long-term (Holter) electrocardiographic recordings. En: 
Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 
4th ed. Philadelphia: WB Saunders; 2004. p. 772-92. 
Kircher M, Lapa C. Novel noninvasive nuclear medicine imaging Techniques 
for cardiac inflammation. Curr Cardiovasc Imaging Rep 2017;10:6. 
Kirkpatrick JN, Wieselthaler G, Strueber M, St John Sutton MG, Rame JE. 
Ventricular assist devices for treatment of acute heart failure and chronic 
heart failure. Heart 2015;101:1091-6. 
Kjeldsen SE, Sica D, Haller H, Cha G, Gil Extremera B, Harvey P. Nifedipine 
plus candesartan combination increases blood pressure control regardless 
of race and improves the side effect profile. J Hypertens 2014;32:2488-98. 
Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, 
et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionu-
clide imaging-Executive Summary. A report of the American College of 
Cardiology/American Heart Association Task Force on Practice Guidelines. 
Circulation 2003;108:1404-18. 
Krauss J, Botto F, Lucas L, Bagnatti R. Consenso argentino de evaluación 
de riesgo cardiovascular en cirugía no cardíaca. Rev Argent Cardiol 
2016;84(Supl. 1):1-38. 
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al. 
2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular asses-
sment and management: The Joint Task Force on non-cardiac surgery: 
cardiovascular assessment and management of the European Society of 
Cardiology (ESC) and the European Society of Anaesthesiology (ESA). 
Eur Heart J 2014;35:2383-431. 
Lacunza-Ruiz FJ, Moya-Mitjans A, Martinez-Alday J, Baron-Esquivias G, 
Ruiz-Granell R, Rivas-Gandara N, et al. Implantable loop recorder allows 
an etiologic diagnosis in one-third of patients. Results of the Spanish reveal 
registry. Circ J 2013;77:2535-41. 
Lau ES, Scott NS. Valvular heart disease and pregnancy. Curr Treat Options 
Cardiovasc Med 2018;20:46. 
Lebo MS, Baxter SM. New molecular genetic tests in the diagnosis of heart 
disease. Clin Lab Med 2014;34:137-56. Review. 
Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, 
PARTNER 2 Investigators. et al. Transcatheter or Surgical Aortic-Valve 
Replacement in Intermediate-Risk Patients. N Engl J Med 2016;374(17): 
1609-20. 
Leon MB,Smith CR, Mack MJ, Miller DC, Moses JW, Svensson LG. Partner 
Trial Investigators. Transcatheter aortic-valve implantation for aortic ste-
nosis in patients who cannot undergo surgery. N Engl J Med 2010;363: 
1597-607. 
LeWinter MM, Imazio M. Pericardial Diseases. En: Zipes DP, Libby P, Bonow 
RO, Mann DL, Tomaselli GF, Braunwald G, eds. Braunwald’s Heart Dis-
ease. A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia: 
Elsevier; 2019. p. 1662-80. 
Liu Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, et al. Impact of healthy 
lifestyle factors on life expectancies in the US population. Circulation 
2018;138:345-55. 
Lluis-Ganella C, Subirana I, Lucas G, Tomas M, Muñoz D, Senti M, et al. 
Assessment of the value of a genetic risk score in improving the estimation 
of coronary risk. Atherosclerosis 2012;222:456-63. 
López-Sendón J, López de Sá E. Mechanical complications of myocardial infarc-
tion. En: Tubaro M, Vranckx P, eds. The European Society of Cardiology 
Textbook of Intensive and Acute Cardiovascular Care. Oxford: Oxford 
University Press; 2015. p. 398-408. 
Macfarlane PW. Lead systems. En: Macfarlane PW, Van Oosterom A, Kligfield 
P, Janse MJ, Camm J, eds. Comprehensive electrocardiology. London: 
Springer-Verlag; 2011. p. 377-425. 
Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, PARTNER 
1 trial investigators. et al. 5-year outcomes of transcatheter aortic valve 
replacement or surgical aortic valve replacement for high surgical risk 
patients with aortic stenosis (PARTNER 1): a randomised controlled trial. 
Lancet 2015;385:2477-84. 
https://booksmedicos.org
576 SECCIÓN II I Cardiología
Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, 
PARTNER 3 Investigators. et al. Transcatheter Aortic-Valve Replacement 
with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med 
2019;380(18):1695-705. 
Marano R, Liguori C, Savino G, Merlino B, Natale L, Bonomo L. Cardiac 
silhouette findings and mediastinal lines and stripes: radiograph and CT 
scan correlation. Chest 2011;139:1186-96. 
Marian AJ, Belmont J. Strategic approaches to unraveling genetic causes of 
cardiovascular diseases. Circ Res 2011;108:1252-69. 
Marian AJ, Braunwald E. Hypertrophic Cardiomyopathy. Genetics, Pat-
hogenesis, Clinical Manifestations, Diagnosis, and Therapy. Circ Res 
2017;121:749-70. 
Marrugat J, Vila J, Baena-Díez JM, Grau M, Sala J, Ramos R, et al. Validez 
relativa de la estimación del riesgo cardiovascular a 10 años en una cohorte 
poblacional del estudio REGICOR. Rev Esp Cardiol 2011;64:385-94. 
Martín Moreiras J, Cruz González I. Manual de imagen en cardiología. Barce-
lona: Ediciones Pulso; 2011. 
McNally EM, Mestroni L. Dilated Cardiomyopathy. Genetic Determinants 
and Mechanisms. Circ Res 2017;121:731-48. 
Mestres CA, Paré JC, Miró JM. Organization and Functioning of a Multidis-
ciplinary Team for the Diagnosis and Treatment of Infective Endocarditis: 
a 30-years Perspective (1985-2014). Rev Esp Cardiol 2015;68:363-8. 
Mitrani RD, Myerburg RJ. Ten advances defining sudden cardiac death. Trends 
Cardiovasc Med 2016;26(1):23-33. 
Mont L, Brugada J. A Practical Approach to Clinical Arrhyhtmology. Barcelona: 
Marge Medica Books; 2010. 
Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, 
et al. 2013 ESC guidelines on the management of stable coronary artery 
disease. Eur Heart J 2013;34:2949-3003. 
Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden Ch, Budaj A, 
et al. Grupo de Trabajo de la Sociedad Europea de Cardiología sobre diag-
nóstico y tratamiento de la cardiopatía isquémica estable. Guía de Práctica 
Clínica de la ESC 2013 sobre diagnóstico y tratamiento de la cardiopatía 
isquémica estable. Rev Esp Cardiol 2014;67:135e1-135e81. 
Morise AP. Exercise testing in nonatherosclerotic heart disease. Hypertrop-
hic cardiomyopathy, valvular heart disease and arrhythmias. Circulation 
2011;123:216-25. 
Motwani M, Swoboda PP, Plein S, Greenwood JP. Role of cardiovascular 
magnetic resonance in the management of patients with stable coronary 
artery disease. Heart 2018;104(11):888-94. 
Moya A, García-Civera R, Croci F, Menozzi C, Brugada J, Ammirati F, et al. 
On behalf of the Bradycardia detection in Bundle Branch Block (B4) study. 
Diagnosis, management, and outcomes of patients with syncope and bundle 
branch block. Eur Heart J 2011;32:1535-41. 
Moya A, Permanyer G, Sagristà J, Carne X, Rius T, Mont L, et al. Limitations 
of head-up tilt test for evaluating the efficacy of therapeutic interventions in 
patients with vasovagal syncope. J Am Coll Cardiol 1995;25:65-9. 
Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Gui-
delines for the diagnosis and management of syncope (version 2009): the 
Task Force for the Diagnosis and Management of Syncope of the European 
Society of Cardiology. Eur Heart J 2009;30:2631-71. 
Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, et al. American 
Heart Association Committee on Exercise, Cardiac Rehabilitation, and 
Prevention of the Council on Clinical Cardiology, the Council on Nutri-
tion, Physical Activity, and Metabolism, and the Council on Cardiovascular 
Nursing. Recommendations for clinical exercise laboratories: a scientific 
from the American Heart Association. Circulation 2009;119:3144-61. 
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, 
ESC Scientific Document Group. et al. 2018 ESC/EACTS Guidelines on 
myocardial revascularization. Eur Heart J 2019;40(2):87-165. 
Newby DE, Adamson PD, Berry C, Boon NA, Dweck MR. SCOT-HEART 
Investigators. Coronary CT Angiography and 5-Year Risk of Myocardial 
Infarction. N Engl J Med 2018;379(10):924-33. 
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher 
LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Gui-
deline for the Management of Patients With Valvular Heart Disease: A 
Report of the American College of Cardiology/American Heart Association 
Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017;70: 
252-89. 
Noriega FJ, Vives-Borrás M, Solé-González E, García-Picart J, Arzamendi 
D, Cinca J. Influence of the extent of coronary atherosclerotic disease on 
ST-segment changes induced by ST elevation myocardial infarction. Am J 
Cardiol 2014;113:757-64. 
Oh JK, Seward JB. The Echo Manual. Philadelphia: Lippincott Williams & 
Wilkins; 2006. 
Oliver JM, Gallego P, Gonzalez-Garcia AE, Garcia-Hamilton D, Peinado R, 
Avila P, et al. Risk factor for excess mortality in adults with congenital heart 
disease. European Heart Journal 2017;38:1233-41. 
Otto CM, Schwaegler RG, Freeman R. Echocardiography Review Guide. 
Philadelphia: Elsevier/Saunders; 2011. 
Pericas JM, Llopis J, Cervera C, Sacanella E, Falces C, Andrea R, et al. Infective 
endocarditis in patients with an implanted transcatheter aortic valve: clinical 
characteristics and outcome of a new entity. J Infect 2015;70:565-76. 
Perloff JK, Warnes CA. Challenges posed by adults with repaired congenital 
heart disease. Circulation 2001;103:2637-43. 
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons S, Catapano AL, et al. 
2016 European Guidelines on cardiovascular disease prevention in clinical 
practice. The Sixth Join Task Force of the European Society of Cardiology 
and other Societies on Cardiovascular Prevention in Clinical Practice. Eur 
Heart J 2016;37:2315-81. 
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, 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;37:2129-200. 
Pons-Lladó G. Protocols for Cardiac MR and CT. Switzerland: Springer Inter-
national Publishing; 2016. 
Puntmann VO, Peker E, Chandrashekhar Y, Nagel E. T1 Mapping in 
Characterizing Myocardial Disease. A ComprehensiveReview. Circ Res 
2016;119(2):277-99. 
Rader DJ. Human genetics of atherothrombotic disease and its risk factors. 
Arterioscler Thromb Vasc Biol 2015;35:741-7. 
Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, 
Mumtaz M, et al. SURTAVI Investigators. Surgical or Transcatheter 
Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med 
2017;376(14):1321-31. 
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, 
Cífková R, ESC Scientific Document Group. et al. 2018 ESC Guidelines 
for the management of cardiovascular diseases during pregnancy. Eur Heart 
J 2018;39:3165-241. 
Roffi M, Patrono C, Collet JP, Mueler C, Valgimigli M, Andreotti F, et al. 
2015 ESC Guidelines for the management of acute coronary syndromes 
in patients presenting without persistent ST-segment elevation. Eur Heart 
J 2016;37:267-315. 
Sabaté M, Brugaletta S. Percutaneous Cardiac Interventions: Tips and Tricks of 
New Techniques beyond Stenting. 2nd ed. Toulouse: Europa Edition; 2019. 
Sharma S, Bhargava A, Krishnakumar R, Rajani M. Can pulmonary venous 
hypertension be graded by the chest radiograph? ClinRadiol 1998;53:899. 
Sitges M, Paré C. Ecocardiografía en el paciente crítico. En: Nicolás JM, Ruiz 
Moreno J, Jiménez Fábrega X, Castel À, eds. Enfermo crítico y emergencias. 
Barcelona: Elsevier; 2010. 
Steinberg ZL, Domínguez-Islas CP, Otto CM, Stout KK, Krieger EV. Maternal 
and fetal outcomes of anticoagulation in pregnant women with mechanical 
heart valves. J Am Coll Cardiol 2017;69:2681-91. 
Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. 
COAPT Investigators. Transcatheter Mitral-Valve Repair in Patients with 
Heart Failure. N Engl J Med 2018;379(24):2307-18. 
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B1, Broberg CS, Colman JM, 
et al. 2018 AHA/ACC Guideline for the Management of Adults With 
Congenital Heart Disease: Executive Summary: A Report of the American 
College of Cardiology/American Heart Association Task Force on Clinical 
Practice Guidelines. Circulation 2019;139(14):e637-97. 
Subirana I, Fitó M, Diaz O, Vila J, Francés A, Delpon E, et al. Prediction of 
coronary disease incidence by biomarkers of inflammation, oxidation, and 
metabolism. Sci Rep 2018;8:3191. 
Task Force for the Diagnosis, Management of Hypertrophic Cardiomyopathy 
of the European Society of Cardiology (ESC). 2014 ESC Guidelines on 
diagnosis and management of hypertrophic cardiomyopathy. Eur Heart J 
2014;35:2733-79. doi: 10.1093/eurheartj/ehu284. 
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. 
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic 
heart failure. European Heart Journal 2016;37(27):2129-200. 
Thibodeau JT, Turer AT, Gualano SK, Ayers CR, Velez-Martinez M, Mishkin 
JD, et al. Characterization of a novel symptom of advanced heart failure: 
bendopnea. JACC HeartFail 2014;2:24-31. 
Thiele H, Ohman EM, Desch S, Eitel I, de Waha S. Management of cardiogenic 
shock. Eur Heart J 2015;36:1223-30. 
Thomson WR, Gordon NF, Pescatello LS. ACSM’s Guidelines for Exercise 
Testing and Prescription. 8th ed. Philadelphia: Lippincott Williams & 
Wilkins; 2010. 
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. 
Fourth universal definition of myocardial infarction (2018). Eur Heart J 
2019;40:237-69. 
https://booksmedicos.org
577 CAPÍTULO 64 Valoración del riesgo quirúrgico del paciente con cardiopatía
S
E
C
C
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N
 I
II
Vives-Borras M, Maestro A, Garcia-Hernando V, Jorgensen D, Ferrero-Gregori 
A, Mustafa A, et al. Electrocardiographic distinction of left circumflx and 
right coronary artery occlusion in patients with inferior acute myocardial 
infaction. Am J Cardiol 2019;123:1019-25. 
Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. 
En: Zipes, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart 
Disease. Philadelphia: Elsevier/Saunders; 2005. p. 1489-552. 
Wellens HJJ, Conover M. The ECG in acute ST segment elevation myocardial 
infarction. En: Wellens HJJ, Conover M, eds. The ECG in emergency 
decision making. St. Louis: Saunders/Elsevier; 2006. p. 1-60. 
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison 
Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/
ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Eva-
luation, and Management of High Blood Pressure in Adults: Executive 
Summary: A Report of the American College of Cardiology/American 
Heart Association Task Force on Clinical Practice Guidelines. Hypertension 
2018;71:1269-324. 
Williams B, Mancia G, Spiering W, Agabiti-Rosei E, Azizi M, Burnier M, et al. 
2018 ESC/ESH Guidelines for the management of arterial hypertension: 
The Task Force for the management of arterial hypertension of the European 
Society of Cardiology and the European Society of Hypertension: The Task 
Force for the management of arterial hypertension of the European Society 
of Cardiology and the European Society of Hypertension. J Hypertens 
2018;36:1953-2041. 
Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, 
SPRINT Research Group. et al. A randomized trial of intensive versus 
standard blood-pressure control. N Engl J Med 2015;373:2103-16. 
Yancy CW, Jessup M, Bozkurt B, Butler J, Casely DE Jr, Colvin MM, 
et al. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological 
Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline 
for the Management of Heart Failure. A Report of the American College 
of Cardiology/American Heart Association Task Force on Clinical Practice 
Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 
2016;134:e282-93. 
Yancy CW, Jessup M, Bozkurt B, Butler J, Casely DE Jr, Colvin MM, 
et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA 
Guideline for the Management of Heart Failure. A Report of the American 
College of Cardiology/American Heart Association Task Force on Clinical 
Practice Guidelines and the Heart Failure Society of America. J Am Coll 
Cardiol 2017;136:e137-61. 
Yusuf S, Bosch J, Dagenais G, Xavier D, Liu L, Pais P, et al. HOPE-3 inves-
tigators. Cholesterol lowering in intermediate-risk persons without cardio-
vascular disease. N Engl J Med 2016;374:2021-31. 
Zareba W, Kennedy HL, Katritsis DG, Siontis GCM, Camm AJ, Rosero 
SZ, et al. Ambulatory ECG monitoring: clinical practice and research 
applications. Progress in Cardiovascular Diseases 2013;56:125-229. 
Zaret BL, Beller GA. Clinical Nuclear Cardiology. State of the Art and Future 
Directions. Philadelphia: Elsevier Mosby; 2005. 
Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, 
et al. American College of Cardiology/American Heart Association Task 
Force; European Society of Cardiology Committee for Practice Guideli-
nes; European Heart Rhythm Association; Heart Rhythm Society. ACC/
AHA/ESC 2006 Guidelines for Management of Patients With Ventricular 
Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the 
American College of Cardiology/American Heart Association Task Force 
and the European Society of Cardiology Committee for Practice Guidelines 
(writing committee to develop Guidelines for Management of Patients With 
Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): 
developed in collaboration with the European Heart Rhythm Association 
and the Heart Rhythm Society. Circulation 2006;114:e385-484. 
https://booksmedicos.org
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