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