non solo disfunzione diastolica

S. Carerj, MD, FESC

Cardiologia, Università di Messina

XXV Congresso Nazionale ANCE

Taormina 8-11 Maggio 2015

“Scompenso Cardiaco a FE conservata”

Guidelines ESC 2012

Solo disfunzione diastolica?

Cut-off Sm 4.4 cm/sec

Cut-off EF 50 %

Approximately one half of patients with DHF and another one seventh with DD had subnormal mean SM.

Yu CM, Circulation 2002Yu CM, Circulation 2002

Carlsson M Am J Physiol Heart Circ Physiol 2007Carlsson M Am J Physiol Heart Circ Physiol 2007

60% of Stroke Volume is related to AVPD, the60% of Stroke Volume is related to AVPD, theremaining 40% is determined by radial functionremaining 40% is determined by radial function

Pathophysiology of Heart Failure With a Normal Ejection Fraction

Ting Tan Y, JACC 2009

Nagueh SF, Eur J of Echoc- 2009.

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5

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15

20

25

30

35

40

ML

VD

P

E/E' < 8 E/E' 8-15 E/E' > 15

Assessment of Filling PressureTissue Doppler Ratio

Ommen SR, Ommen SR, Circulation 102: 1788, 2000Circulation 102: 1788, 2000

Pathophysiology of Heart Failure With a Normal Ejection Fraction

Ting Tan Y, JACC 2009

Arterial-Ventricular Coupling: Role of the

Stiffness

Vlacahopoulos C, Cardiology 2010

J Am Soc Echocardiogr. 2009; 22: 1246-8

The performance of the cardiovascular system depends on the interaction of its components. The left ventricle pumps is stroke volume into the arterial system, which then delivers the flow to the tissues. Thus, optimal cardiovascular function requires appropriate coupling of the left ventricle and arterial system.

Physiologic Properties of The Aorta

Cavalcante JL, JACC 2011

Insulting Leading To Structural Changes in The Aorta and Its

Functioning

Cavalcante JL, JACC 2011

Arterial-Ventricular Coupling: Role of the

Stiffness

Vlacahopoulos C, Cardiology 2010

Relationship between stiffness and diastolic parameters

Zito C, JCM 2014

JCM 2014

Diastolic Velocity Time Integral Coronary Index

Cusmà Piccione M., JCM 2014

Correlazione fra stiffness carotidea e riempimento coronarico

DVTICI

Cusmà Piccione M, JCM 2014

Pathophysiology of Heart Failure With a Normal Ejection Fraction

Ting Tan Y, JACC 2009

Sengupta JASE 2007

ANATOMY OF A VORTEXANATOMY OF A VORTEX

Longitudinal strain and torsion assessed by two-dimensional speckle tracking correlate with the serum level of tissue inhibitor of matrix metalloproteinase-1, a marker of myocardial fibrosis, in patients with hypertension

• Kang SJ. J Am Soc Echocardiogr 2008;21:907-911.

Longitudinal strain Twist

““MOLECULAR Imaging”MOLECULAR Imaging”

Borlaug BA, Eur Heart J 2011

Pathophysiology of HF with Preserved Ejection Fraction

Strain Longitudinale e Circonferenziale in pazienti con HFpEF

Kraigher-Krainer L, JACC 2014

Strain Longitudinale e NT-proBNP

Kraigher-Kraimer E, JACC 2014

Myocardial Deformation

Echocardiography 2010

Pathophysiology of Heart Failure With a Normal Ejection Fraction

Ting Tan Y, JACC 2009

Effect of Exercise in LV Paramters in Patients with HF with Preserved EF

Borlaug BA, Eur Heart J 2011

In HFpEF patients, moderate exercise leads to a steep increase in proximal afterload that is understimated at rest and is associated with unfavorable ventricular-arterial coupling and exrecise intolerance.

Tartiere Kestri L, JACC 2012

Exercise Test in Patients with HF and Preserved EF

Volumi Atriali Sin. e Frazione di Svuotamento Atriale nella HFPEF

Melenovsky V, JACC 2007

Melenovsky V, JACC 2007

Riserva atriale sinistra in pazienti con HFpEF

Algoritmo Diagnostico della HFpEF

Todaro MC, JCM 2014

•Grazie per l’attenzione