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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 DD 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 40 35 MLVDP 30 25 20 15 10 5 0 E/E' < 8 E/E' 8-15 E/E' > 15 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 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. 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 HFpEF Melenovsky V, JACC 2007 Algoritmo Diagnostico della HFpEF Todaro MC, JCM 2014 •Grazie per l’attenzione