IC en VD en fraccion de ejeccion conservado

Jul 4, 20240 likes7 views

VD en IC preservada

$Is the right ventricle relevant in heart failure with preserved ejection fraction? Felix C. Tanner, MD Associate Professor, Cardiology Director, Echocardiography University Heart Center Zürich$

$IC en VD en fraccion de ejeccion conservado$

Anatomy of Right Ventricle
Leonardi B. et al. Eur Heart J Cardiovasc Imaging 2013;14:381-386

Right Ventricular Systolic Function - TAPSE

Right Ventricular Systolic Function - Fractional Area Change

Saguner A.M. et al. Circ Cardiovasc Imaging 2014;7:230-239
Right Ventricular Systolic Function and Outcome
TAPSE FAC

Hahn RT. Circ Cardiovasc Imaging 2016
Tricuspid Regurgitation

Fröhlich GM et al. Eur Heart J 2013;34:1414-1423
Tricuspid Regurgitation And Outcome
Nath J et al. J Am Coll Cardiol 2004;43:405-409
n = 5‘223 (retrospective study)
mean follow up = 498±402 days
Independent of LVEF and PAH

Dyspnea and HFpEF
Dalos D. et al. J Am Coll Cardiol 2016;68:189-199
n=193; prospective cohort study.

Right Ventricle and HFpEF
Mohammed S.F. et al. Circulation 2014;130:2310-2320
C
B
A Prospective
cohort
study
n=562
LV-EF >= 50%
Heart failure
Median follow-
up = 4.6 a
TAPSE = 17 mm
(14-21)

Clinical Parameters and RV Function
Mohammed S.F. et al. Circulation 2014;130:2310-2320

Cardiac Parameters and RV Function
Mohammed S.F. et al. Circulation 2014;130:2310-2320

RV Function and Survival (All-Cause Mortality)
Pulmonary Artery Pressure and Survival (All-Cause Mortality)
Mohammed S.F. et al. Circulation 2014;130:2310-2320

RV Function and Outcome
Mohammed S.F. et al. Circulation 2014;130:2310-2320

Right Ventricular FAC and HFpEF
Melenovsky V. et al. Eur Heart J 2014;35:3452-3462
Distribution of RV Function Survival and RV Function

Melenovsky V. et al. Eur Heart J 2014;35:3452-3462
Predictors of mortality
Right Ventricular FAC and HFpEF

Right Ventricle and HFpEF During Exercise
Borlaug B. et al. Eur Heart J 2016;37:3294-3302
Exercise Hemodynamics
n = 50 (HFpEF), n = 24 (control), Heart failure symptoms, LV-EF >= 50%
Invasive hemodynamic exercise stress test with simultaneous echo
Mildly elevated LV and RV filling pressure at rest
Mildy elevated PA systolic pressure at rest (mPAP = 27±8 mmHg
Normal RV tissue velocities (S‘ and E‘) at rest

Right Ventricle and HFpEF During Exercise
Borlaug B. et al. Eur Heart J 2016;37:3294-3302
Ventricular Tissue Velocities

Right Ventricle and HFpEF - Metaanalysis
Gorter T.M. et al. Eur J Heart Fail 2016;18:1472-1487
RV Systolic Parameters as Predictor of Mortality

Right Ventricle and HFpEF
• Right ventricular dysfunction, CMR, prognosis
Aschauer S et al. Eur J Heart Fail 2016;18:71-80
• Right ventricular dysfunction, comorbidities, prognosis
Aschauer S et al. Int J Cardiol 2017;228:422-426
• Right ventricular dysfunction, HFrEF, prognosis
Ghio S et al. Eur J Heart Fail 2017;19:873-879
• Right ventricular pulmonary artery coupling:
Guazzi M et al. J am Coll Cardiol Img 2017 (in press)

Right Ventricle and HFpEF
x
Chatterjee N.A. et al. Circulation 2014;130:2272-2275 Gorter T.M. et al. Eur J Heart Fail 2016;18:1472-1487

Right Ventricle and HFpEF
• RV dysfunction is frequent in HFpEF, although less
frequent than RV dysfunction in HFrEF
• RV dysfunction contributes to exercise intolerance
in HFpEF
• RV dysfunction in HFpEF is associated with more
advanced disease
• RV dysfunction in HFpEF is associated with worse
outcome
• RV dysfunction appears to predict outcome regard-
less of the severity of pulmonary hypertension

Right Ventricle and HFpEF
• HFpEF primarily affects the left ventricle, but is a biventricular
disorder in many patients
• HFpEF primarily affects diastole, but systole also appears to be
altered
• Echocardiography is the ideal method for assessing both right
ventricle and pulmonary pressure

$IC en VD en fraccion de ejeccion conservado$

1. This document summarizes research on reversing cardiac remodeling through heart failure treatment. It discusses what remodeling is, the history of the term in medical literature, and types of remodeling (pathological vs physiological). 2. Studies show treatments that lead to "reverse remodeling" like sacubitril/valsartan improve outcomes for heart failure patients. Trials like PARADIGM-HF and PROVE-HF found sacubitril/valsartan reduced biomarkers and improved ejection fraction, indicating reverse remodeling. 3. Subgroup analyses in PROVE-HF found consistent reverse remodeling effects in newly diagnosed and ACE-ARB naive patients as well as those not reaching target sacubitril/vals

PH-ILD: Approach to Diagnosis and Treatment.pptxDuke Heart

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This document discusses pulmonary hypertension associated with interstitial lung disease (PH-ILD). It begins with an overview of PH classification and the changes in definitions. PH-ILD prevalence depends on disease severity and definition, ranging from 5-75% in ILD patients. Clinical features that suggest PH-ILD include symptoms out of proportion to lung disease severity, imaging findings, and cardiopulmonary testing results. Diffusion capacity and right ventricular function are predictive of outcomes. While medications for group 1 PH have been studied in PH-ILD with mixed results, treatment is generally based on severity with PDE5 inhibitors and inhaled prostanoids for mild-moderate disease. Lung transplant should be considered for severe PH-ILD.

Cardiac Resynchronisation Therapycardiologycases

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This document summarizes the results of the CARE-HF trial, which investigated the effects of cardiac resynchronization therapy (CRT) in patients with heart failure. The trial found that CRT significantly reduced the risks of death and hospitalization compared to medical therapy alone. For every 9 patients treated with CRT, 1 death and 3 hospitalizations were prevented. The results provide strong evidence that CRT can improve outcomes for appropriately selected heart failure patients.

Cardiac Resynchronisation Therapycardiologycases

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This document summarizes the results of the CARE-HF trial, which investigated the effects of cardiac resynchronization therapy (CRT) in patients with heart failure. The trial found that CRT significantly reduced the risks of death and hospitalization compared to medical therapy alone. For every 9 patients treated with CRT, 1 death and 3 hospitalizations were prevented. The results provide strong evidence that CRT can reduce both morbidity and mortality in patients with moderate to severe heart failure.

Cardiac Resynchronisation Therapycardiologycases

��

This document summarizes the results of the CARE-HF trial, which investigated the effects of cardiac resynchronization therapy (CRT) on morbidity and mortality in patients with heart failure. The trial found that CRT significantly reduced the risks of death and hospitalization compared to medical therapy alone. For every 9 CRT devices implanted, 1 death and 3 hospitalizations were prevented. The results provided evidence that CRT can improve outcomes for patients with heart failure.

Cardiac Resynchronisation Therapycardiologycases

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This document summarizes the results of the CARE-HF trial, which investigated the effects of cardiac resynchronization therapy (CRT) in patients with heart failure. The trial found that CRT significantly reduced the risks of death and hospitalization compared to medical therapy alone. For every 9 patients treated with CRT, 1 death and 3 hospitalizations were prevented. The results provide strong evidence that CRT can reduce both morbidity and mortality in patients with moderate to severe heart failure.

Cardiac Resynchronisation Therapycardiologycases

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Cardiac Resynchronisation Therapycardiologycases

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Sleep Apnea and Heart Failure (2001-06-13)MedicineAndFamily

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The document summarizes research on sleep apnea in heart failure patients. It finds: - Sleep apnea is highly prevalent in heart failure patients, with studies finding 47-49% have an apnea-hypopnea index over 15 events per hour. Central sleep apnea makes up 15-46% of cases. - Central sleep apnea independently predicts mortality in heart failure patients and is associated with reduced left and right ventricular function. - Treatments for central sleep apnea like supplemental nocturnal oxygen, theophylline, acetazolamide, and CPAP can improve sleep quality and reduce apnea episodes and symptoms. However, a large clinical trial found CPAP did not significantly impact heart transplantation-free

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1) HFpEF is the most common form of heart failure, affecting over 70% of heart failure patients over age 65. It is associated with substantial morbidity and mortality. 2) HFpEF is challenging to diagnose because ejection fraction is normal and cardiac congestion is difficult to evaluate non-invasively. It is defined hemodynamically as a clinical syndrome associated with a lack of capacity of the heart to pump blood adequately without elevated cardiac filling pressures. 3) There is currently no effective pharmacological treatment for HFpEF. Treatment focuses on controlling congestion through diuretics, managing comorbidities, and promoting exercise. Future efforts to better characterize HFpEF phenotypes may allow individualized therapies

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AF is associated with increased mortality, but it is unclear if this is directly caused by AF or associated conditions. Studies show AF patients have 1.5-2x higher risk of death than controls (1). While some evidence suggests AF directly increases mortality risk through stroke and heart failure worsening, randomized trials found rhythm control did not reduce mortality compared to rate control (2). It is likely AF directly increases mortality in some patients and is also a marker for worsening of linked conditions. Understanding the AF-mortality relationship could guide new treatments to lower premature death risk.

ARNI, Angiotensin Neprilysin, New Indication.pptx,Dr.Hasan Mahmud

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Heart failure management - role of arniPROFESSOR DR. MD. TOUFIQUR RAHMAN

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1. A Case report of Heart Failure 2. Discussion on Heart Failure 3. Role of Peptides in Heart Failure 4. Importance of 30 days in heart failure 5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF) 6. Biomarkers in Heart Failure 7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study) 8. Role of ARNI in HFpEF (PARAMOUNT Trial) 9. Safety and usefulness of ACEI/ARB/ARNI 10. Role of SGPL2 inhibitors in HF with/without DM

A New Horizon in Pulmonary Hypertension Management Dr.Mahmoud Abbas

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Icaro 2015 pah e ctd cavagnaPahPavia

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This document summarizes information about pulmonary arterial hypertension (PAH) in patients with connective tissue diseases (CTDs). It discusses several key points: - PAH is most prevalent in systemic sclerosis (SSc), occurring in up to 9% of patients. Survival is worse for PAH associated with SSc compared to idiopathic PAH. - Early detection of PAH in SSc is important and can be aided by annual screening with echocardiography, pulmonary function tests, and biomarkers like BNP/NT-proBNP. Stress echocardiography may also help predict PAH. - The DETECT study developed a validated two-step algorithm using non-invasive tests to identify PAH in high

Sex and Gender Differences in PH and Right Ventricular Failure.pptxDuke Heart

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This document discusses sex and gender differences in pulmonary hypertension and right ventricular failure. Some key points include: - Females are more prone to developing pulmonary arterial hypertension than males. Females also exhibit better right ventricular adaptation and function, which contributes to better outcomes and survival in females compared to males. - Estrogens may mediate some of the sex differences observed, as higher estrogen levels are associated with worse pulmonary arterial remodeling but better right ventricular function. The Y chromosome gene UTY also appears protective against pulmonary hypertension in males. - A proposed mechanism is that estrogen signaling through estrogen receptor alpha increases levels of the cardioprotective peptide apelin in right ventricular cardiomyocytes, thereby improving right ventricular function in females

Heart Failure in Women: More than EF?ahvc0858

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This document provides an overview of heart failure, with a focus on heart failure with preserved ejection fraction (HFpEF). It discusses the pathophysiology, diagnosis, and management of HFpEF. Key points include: - HFpEF accounts for about 1/3 to 1/2 of heart failure cases and is associated with abnormal diastolic function. - Diagnosis involves assessing symptoms, imaging like echocardiography to evaluate diastolic dysfunction, and ruling out other potential causes. - Treatment focuses on controlling risk factors like hypertension, fluid management, and some evidence that ARBs, ARNI, and statins may provide benefits. Prognosis is similar to heart failure with reduced eject

Pulmonary hypertention in left heart diseases PH-LHDDr. Lokesh Khandelwal

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hfupdate2021-210808142611.pptx presentacion sacubitril valsartanAnnySuarez8

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Low dose dopamine increases GFR and RBF. The DAD-HF trial investigated 60 patients randomized to low dose furosemide (continuous infusion 0.5 mg/kg/day) with or without low dose dopamine (2 μg/kg/min). Dopamine preserved renal function compared to furosemide alone in patients with acute decompensated heart failure. There were no significant differences found in a trial comparing high vs low dose furosemide or bolus vs continuous infusion on renal function or symptoms. Novel agents targeting fluid overload, renal function, contractility, and vasomotion may provide new therapeutic options for acute heart failure.

Acute Decompensated Heart Failure CSI13drucsamal

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Prof. U. C. SAMAL provides an overview of acute decompensated heart failure and what is new in the field. He discusses similarities and differences between acute myocardial infarction and acute heart failure syndromes. Mortality rates are high for both conditions, though clinical benefits of interventions are greater for acute MI based on published clinical trials. The document then discusses definitions and classifications of acute heart failure syndromes, as well as guidelines for diagnosis and treatment from ESC and ACC/AHA. Biomarkers that can help with diagnosis, prognosis, and guiding therapy are also summarized.

Pulmonary Hypertension Basics 2023.pptxDuke Heart

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$Heart Failure With reduce Ejection fraction$ $Heart Failure With reduce Ejection fraction$

Heart Failure With reduce Ejection fractionRenovOmpusunggu1

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Guidelines and beyond new drug therapy for heart failure with reduced ejectio...ahvc0858

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This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies

Hemodynamic Evaluation of Pulmonary Hypertension: Principles and Best PracticesDuke Heart

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This document provides an overview of Ryan Tedford's presentation on best practices for right heart catheterization and hemodynamic evaluation of pulmonary hypertension. Some key points discussed include: - Always perform an RHC before starting PAH therapy to accurately diagnose pre- or post-capillary disease. - Obtaining an accurate PAWP measurement is critical, as it distinguishes pre- from post-capillary disease. Factors like respiratory variation, cardiac cycle timing, and catheter positioning impact PAWP values. - Thermodilution cardiac output and modified Fick methods were discussed alongside their limitations in certain patient populations. - A case example highlighted the importance of confirming PAWP values with a saturation to rule out partial occlusion effects

HFPEF 2017 Scompenso cardiaco con FE normaleUniversity of Messina (Italy)

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1. Preserved ejection fraction (HFpEF) - also referred to as diastolic heart failure. Ejection fraction (EF) is commonly used to classify heart failure (HF) but it has limitations as a marker of systolic function. 2. EF alone does not necessarily indicate normal systolic function, as parameters like strain and twisting may be impaired even with normal EF. EF also depends on preload (end-diastolic volume) so stroke volume can be low with normal EF. 3. The distribution of EF in the population and in HF patients is continuous rather than discrete, and EF values can change over time, with some patients transitioning between preserved and reduced EF categories.

Devices in the Management of Chronic Heart FailureDuke Heart

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Chair, Grzegorz (Greg) S. Nowakowski, MD, FASCO, discusses diffuse large B-cell lymphoma in this CME activity titled “Addressing Unmet Needs for Better Outcomes in DLBCL: Leveraging Prognostic Assessment and Off-the-Shelf Immunotherapy Strategies.” For the full presentation, downloadable Practice Aid, and complete CME information, and to apply for credit, please visit us at https://bit.ly/49JdxV4. CME credit will be available until February 27, 2026.

Public health 101 x health disinformation.pptxTina Purnat

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IC en VD en fraccion de ejeccion conservado

1. Is the right ventricle relevant in heart failure with preserved ejection fraction? Felix C. Tanner, MD Associate Professor, Cardiology Director, Echocardiography University Heart Center Zürich

6. Anatomy of Right Ventricle Leonardi B. et al. Eur Heart J Cardiovasc Imaging 2013;14:381-386

7. Right Ventricle - 3D

8. Right Ventricular Systolic Function - TAPSE

9. Right Ventricular Systolic Function - Fractional Area Change

10. Saguner A.M. et al. Circ Cardiovasc Imaging 2014;7:230-239 Right Ventricular Systolic Function and Outcome TAPSE FAC

11. Tricuspid Regurgitation

12. Hahn RT. Circ Cardiovasc Imaging 2016 Tricuspid Regurgitation

13. Fröhlich GM et al. Eur Heart J 2013;34:1414-1423 Tricuspid Regurgitation And Outcome Nath J et al. J Am Coll Cardiol 2004;43:405-409 n = 5‘223 (retrospective study) mean follow up = 498±402 days Independent of LVEF and PAH

14. Dyspnea and HFpEF Dalos D. et al. J Am Coll Cardiol 2016;68:189-199 n=193; prospective cohort study.

15. Right Ventricle and HFpEF Mohammed S.F. et al. Circulation 2014;130:2310-2320 C B A Prospective cohort study n=562 LV-EF >= 50% Heart failure Median follow- up = 4.6 a TAPSE = 17 mm (14-21)

16. Clinical Parameters and RV Function Mohammed S.F. et al. Circulation 2014;130:2310-2320

17. Cardiac Parameters and RV Function Mohammed S.F. et al. Circulation 2014;130:2310-2320

18. RV Function and Survival (All-Cause Mortality) Pulmonary Artery Pressure and Survival (All-Cause Mortality) Mohammed S.F. et al. Circulation 2014;130:2310-2320

19. RV Function and Outcome Mohammed S.F. et al. Circulation 2014;130:2310-2320

20. Right Ventricular FAC and HFpEF Melenovsky V. et al. Eur Heart J 2014;35:3452-3462 Distribution of RV Function Survival and RV Function

21. Melenovsky V. et al. Eur Heart J 2014;35:3452-3462 Predictors of mortality Right Ventricular FAC and HFpEF

22. Right Ventricle and HFpEF During Exercise Borlaug B. et al. Eur Heart J 2016;37:3294-3302 Exercise Hemodynamics n = 50 (HFpEF), n = 24 (control), Heart failure symptoms, LV-EF >= 50% Invasive hemodynamic exercise stress test with simultaneous echo Mildly elevated LV and RV filling pressure at rest Mildy elevated PA systolic pressure at rest (mPAP = 27±8 mmHg Normal RV tissue velocities (S‘ and E‘) at rest

23. Right Ventricle and HFpEF During Exercise Borlaug B. et al. Eur Heart J 2016;37:3294-3302 Ventricular Tissue Velocities

24. Right Ventricle and HFpEF During Exercise Borlaug B. et al. Eur Heart J 2016;37:3294-3302 Ventricular Tissue Velocities

25. Right Ventricle and HFpEF - Metaanalysis Gorter T.M. et al. Eur J Heart Fail 2016;18:1472-1487 RV Systolic Parameters as Predictor of Mortality

26. Right Ventricle and HFpEF • Right ventricular dysfunction, CMR, prognosis Aschauer S et al. Eur J Heart Fail 2016;18:71-80 • Right ventricular dysfunction, comorbidities, prognosis Aschauer S et al. Int J Cardiol 2017;228:422-426 • Right ventricular dysfunction, HFrEF, prognosis Ghio S et al. Eur J Heart Fail 2017;19:873-879 • Right ventricular pulmonary artery coupling: Guazzi M et al. J am Coll Cardiol Img 2017 (in press)

27. Right Ventricle and HFpEF x Chatterjee N.A. et al. Circulation 2014;130:2272-2275 Gorter T.M. et al. Eur J Heart Fail 2016;18:1472-1487

28. Right Ventricle and HFpEF • RV dysfunction is frequent in HFpEF, although less frequent than RV dysfunction in HFrEF • RV dysfunction contributes to exercise intolerance in HFpEF • RV dysfunction in HFpEF is associated with more advanced disease • RV dysfunction in HFpEF is associated with worse outcome • RV dysfunction appears to predict outcome regard- less of the severity of pulmonary hypertension

29. Right Ventricle and HFpEF • HFpEF primarily affects the left ventricle, but is a biventricular disorder in many patients • HFpEF primarily affects diastole, but systole also appears to be altered • Echocardiography is the ideal method for assessing both right ventricle and pulmonary pressure

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