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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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15
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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