XXV Congresso Nazionale ANCE Taormina 8 11 Maggio

XXV Congresso Nazionale ANCE Taormina 8 -11 Maggio 2015 “Scompenso Cardiaco a FE conservata” non solo disfunzione diastolica S. Carerj, MD, FESC Cardiologia, Università di Messina

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 D had subnormal mean SM. Yu CM, Circulation 2002

60% of Stroke Volume is related to AVPD, the remaining 40% is determined by radial function Carlsson M Am J Physiol Heart Circ Physiol 2007

Pathophysiology of Heart Failure With a Normal Ejection Fraction Ting Tan Y, JACC 2009

Nagueh SF, Eur J of Echoc- 2009.

Assessment of Filling Pressure Tissue Doppler Ratio Ommen SR, Circulation 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

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

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

ANATOMY OF A VORTEX Sengupta JASE 2007

“MOLECULAR Imaging” 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

Pathophysiology of HF with Preserved Ejection Fraction Borlaug BA, Eur Heart J 2011

Strain Longitudinale e Circonferenziale in pazienti con HFp. EF Kraigher-Krainer L, JACC 2014

Strain Longitudinale e NT-pro. BNP 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 HFp. EF 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.

Exercise Test in Patients with HF and Preserved EF Tartiere Kestri L, JACC 2012

Volumi Atriali Sin. e Frazione di Svuotamento Atriale nella HFPEF Melenovsky V, JACC 2007

Riserva atriale sinistra in pazienti con HFp. EF Melenovsky V, JACC 2007

Algoritmo Diagnostico della HFp. EF Todaro MC, JCM 2014

• Grazie per l’attenzione