Cálculo de resistencia vascular sistémica por ecocardiografía en la insuficiencia cardíaca crónica: una herramienta para optimizar la dosis de IECA y ARA II

background. angiotensin converting enzyme inhibitors and angiotensin receptor blockers improve heart failure prognosis, but many patients are not treated with target doses. objective. our aim was to determine if the echocardiographic measurement of systemic vascular resistance could increase the number of patients treated with optimal doses. material and methods. patients with heart failure due to systolic dysfunction and no contraindications to enalapril/ losartán were included. the target doses considered were enalapril/losartán ≥ 20/25mg/day. patients were randomized to adjusted dose using clinical approach and systemic vascular resistance vs clinical parameters only (groups a and b). in group a if systemic vascular resistance was ≥ 1200 dynes.sec/cm-5, enalapril dose was increased 25% up to 40mg and then losartán was added (unless contraindication). the main outcome measures in follow-up were changes in proportion of patients receiving enalapril/losartán target doses, comparing recruit vs last control in both groups. results. seventy patients (50 males, age 60±12 years old, 30 in functional class i, systemic vascular resistance 2033±802 dines.seg.cm-5), were included and followed-up for 12.3±months. there were no significant basal differences between groups. in group a significant increase was observed in the proportion of patients receiving target dose of enalapril/losartán (50% recruit vs 64% last control, p < 0.01). in group b a significant decrease was observed in the same proportion (59% vs 47%, p <0.05). conclusion. more patients with heart failure received target doses of enalapril/losartán, when echocardiographic measurement of systemic vascular resistance was used.