Ipertensione polmonare nel Ipertensione polmonare nel gruppo 2 gruppo 2 Rita Camporotondo Rita Camporotondo Divisione di Cardiologia Divisione di Cardiologia Fondazione IRCCS Policlinico S Matteo, Fondazione IRCCS Policlinico S Matteo, Pavia Pavia Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Ipertensione polmonare nel gruppo 2Ipertensione polmonare nel gruppo 2
Rita Camporotondo Rita Camporotondo
Divisione di CardiologiaDivisione di Cardiologia
Fondazione IRCCS Policlinico S Matteo, PaviaFondazione IRCCS Policlinico S Matteo, Pavia
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
• Prevalence of PH depends on the population studied:
in referral centers about 2/3 of pts evaluated for potential heart transplant listing has PH.
PH in systolic dysfunction of the left ventriclePH in systolic dysfunction of the left ventricle
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
1.1. Pathophysiology of PH in LV systolic Pathophysiology of PH in LV systolic dysfunction. dysfunction.
2. Clinical implications of PH.
3. Treatment of PH.
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
Pathophysiology of PH in LV systolic dysfunction: Pathophysiology of PH in LV systolic dysfunction: backward transmission of high filling pressure. backward transmission of high filling pressure.
1000 HF pts undergoing transplant evaluation
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
Left atrial function at echoLeft atrial function at echo
was the strongest predictor
of sPA in pts with/without mitral regurgitation
• Sarano ME. JACC 1997
• 102 HF pts
PH not related to EF but strongly related to degree of degree of mitral regurgitation and mitral regurgitation and DTDT
Pathophysiology of PH in LV systolic dysfunction: Pathophysiology of PH in LV systolic dysfunction: backward transmission of high filling pressure. backward transmission of high filling pressure.
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
46 HF pts, LVEF <30%, baseline and exercise Doppler echo46 HF pts, LVEF <30%, baseline and exercise Doppler echo
<Independent predictors of PASP at rest were left atrial volume <Independent predictors of PASP at rest were left atrial volume (p=0.006), E wave velocity (p=0.02), mitral tenting area (p=0.005)(p=0.006), E wave velocity (p=0.02), mitral tenting area (p=0.005)
..A larger rise in mitral regurgitant volume during exercise emerged..A larger rise in mitral regurgitant volume during exercise emergedas the single determinant of exercise induced increase in PASP>as the single determinant of exercise induced increase in PASP>
Cody RJ, Circulation 1992
EndothelinEndothelin plasma levels correlate with PH in HF pts
Dupuis J, Circulation 1996EndothelinEndothelin spill over in the
lungs correlates with PVR in HF pts
Cooper CJ, Am J Cardiol, 1998
L-NMMA (NONO inhibitor) 6 controls, 9 HF + normal PVRI,9 HF+ ↑ PVRI.Response to L-NMMA was less
in pts with HF and hight PVRI. Impaired endothelial NO function
Pathophysiology of PH in LV systolic dysfunction: Pathophysiology of PH in LV systolic dysfunction: reactive increase in resistances.reactive increase in resistances.
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
1.1. Pathophysiology of PH in LV systolic Pathophysiology of PH in LV systolic dysfunction. dysfunction.
2. Clinical implications of PH.
3. Treatment of PH.
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
Clinical implications:Clinical implications:reduced exercise tolerance in HF pts. reduced exercise tolerance in HF pts.
• It is NOT PH “per se”, rather it is the right ventricular dysfunction determined by PH to reduce the exercise tolerance.
Butler J, JACC 1999
320 HF pts: ex testing + RHC
High PVR = low peak VO2
A substantial proportion of pts decreased PCWP and increase RAP during exercise, indicating RV failure RV failure
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011
Cappola TP, Circulation 2002
1134 pts with CM undergoing RHCreferred to John Hopkins for hearttransplant evaluation.
mPAmPA was the most important hemo.risk factor. MyocarditisMyocarditis pts also were at higherrisk (acute PH, RV failure).
Clinical implications:Clinical implications:poor prognosis in HF pts. poor prognosis in HF pts.
Corso di aggiornamento sull’ Ipertensione Polmonare. Pavia, 20-21 Maggio 2011