Repercusión hemodinámica en cardiopatías congénitas: subanálisis para detección precoz desde la medicina familiar

Congenital heart diseases with pulmonary hyperflow can progress to subclinical hemodynamic compromise. Early identification of these conditions is frequently difficult in primary health care settings. To identify clinical variables accessible in primary care that are associated with significant hemodynamic compromise. A longitudinal analytical study was conducted at the Cardiology outpatient clinic of the Hermanos Cordové Hospital in Manzanillo, Granma, over a 7-year study period. The study included 312 pediatric patients with a ventricular septal defect, atrial septal defect, or patent ductus arteriosus. Eleven clinical variables were extracted (heart murmur, hepatomegaly, tachypnea, baseline O2 saturation, gallop rhythm, respiratory rate, expiratory grunting, subcostal retractions, age, weight, and the echocardiographic Qp/Qs ratio as the gold standard). Multivariate logistic regression was performed. The prevalence of hemodynamic compromise was 31.7 % (99 / 312; 95 % CI: 26.6-37.1). When compared with the 213 patients without hemodynamic compromise, the cases with compromise exhibited a significantly higher frequency of tachypnea at rest (76 % vs. 18 %; p < 0.001), hepatomegaly ≥ 2 cm (68 % vs. 12 %; p < 0.001), and O2 saturation ≤ 94% (71 % vs. 15 %; p < 0.001). In the multivariate analysis, adjusted for age and sex, these three variables maintained an independent association: tachypnea (OR 4.2; 95 % CI: 2.5-7.1; p < 0.001) and O2 saturation ≤ 94 % (OR 5.1; 95 % CI: 3.0–8.7; p < 0.001). No significant differences were observed regarding the other eight variables explored. The presence of tachypnea, hepatomegaly, and low oxygen saturation are clinically accessible signs in family medicine that are independently associated with hemodynamic compromise. Their early identification can guide timely referral.