Aξιολόγιση του ασθενούς με δυσλειτουργία της αριστερής κοιλίας και προοπτική επαναγγείωσης. Αθανάσιος Κρανίδης

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1 Aξιολόγιση του ασθενούς με δυσλειτουργία της αριστερής κοιλίας και προοπτική επαναγγείωσης Αθανάσιος Κρανίδης

2 Ιntroduction Coronaty artery disease is believed to be the underlying cause in over 2/3 of pts with heart failure and low LVEF. There for a common clinical senario is the patient with left ventricular dysfunction who needs evaluation for possible coronary revascularization Novel Techniquesfor for imaging the heart,1st edition. Di Carli and R.Kwong, 2008 Am Heart Ass.

3 A) Assessment of coronary lesions, EF and myocardial viability

Circulation. 2012 Sep 11;126:3-8. Survival in patients with severe ischemic cardiomyopathy undergoing revascularization versus medical therapy: association with end-systolic volume and viability.

5 Circulation Sep 11;126:3-8. Survival in patients with severe ischemic cardiomyopathy undergoing revascularization versus medical therapy: association with end-systolic volume and viability. Kwon DH et al End-systolic volume index and viability as myocardial scar burden provide independent, incremental prognostic value in patients with severe ischemic cardiomyopathy. Better survival was associated with lower volumes and less scar.

7 Α) JCHF. 2013;1(5): In the STICH trial, the addition of CABG to medical therapy reduced the most common modes of death: sudden death and fatal pump failure events. The beneficial effects were principally seen after 2 years. Post-procedure deaths were increased in patients randomized to CABG, whereas myocardial infarction deaths were decreased.

8 JACC Heart Fail Aug;2(4): Exercise capacity and mortality in patients with ischemic left ventricular dysfunction randomized to CABG or medical therapy: an analysis from the STICH trial (Surgical Treatment for IschemicHeart Failure). Stewart RA1,et al. Patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercise capacity have improved survival with CABG.

9 Sach BN,Curr Opin Card 2014

11 Sach BN,Curr Opin Card 2014

13 Α.Κρανίδης Ι.Παρασκευαίδης Η καρδιακή ανεπάρκεια σε ερωτήσεις απαντήσεις. Αθηνα 2014, Εκδόσεις Παρισιάνος.

14 ΑΙΜΙ-ΗF The AIMI-HF study is a prospective randomized controlled trial, currently recruiting patients, that aims to compare advanced imaging guided care (using PET/MRI) vs standard imaging guided care (using SPECT) and may give clues as to the optimal use of imaging in ICM patients

15 Sach BN,Curr Opin Card 2014

16 DSE

18 B) Assessment of the remodeling and aneurysm of the left ventricle

19 C)LV Remodelling Post MI Acute infarction (hours) Infarct expansion (hours to days) Global remodelling (days to months)

20 3D ECHO 3D MRI

Method combining surgery with gadolinium-enhanced MR A novel method combining surgery with gadolinium-enhanced MR to construct a preoperative 3D systolic heart model was created.

21 Method combining surgery with gadolinium-enhanced MR A novel method combining surgery with gadolinium-enhanced MR to construct a preoperative 3D systolic heart model was created. The model was utilized to determine resection points that could be intraoperatively used. Using this model, we were able to find the optimal resection line providing an excellent postoperative result, thus minimizing the risk of low CO. Hartyánszky I1, ET AL.Interact Cardiovasc Thorac Surg Nov;19(5):801-6; Personalized surgical repair of left ventricular aneurysm with computer-assisted ventricular engineering.

22 Aneurysmal LV Commonly, the aneurysmal LV is associated with milder LV remodelling and has healthy myocardial segments in its basal part. Therefore, in the comparison of the patients with similar LV volumes and LVEF, the LV shape could be an important predictor of adverse outcomes after SVR. Fazal IA1, Bates MG, Matthews IG, Turley AJ Interact Cardiovasc Thorac Surg Jun;12(6):

23 C) ASSESSMENT OF MR

γλωχίνων >11 χιλ γ) ελκτική επιφάνεια (tenting area) >1,6cm2 δ) ανεπάρκεια >3/4 A.

26 Πρόβλεψη μη επιθυμητού αποτελέσματος μετά τη πλαστική της βαλβίδας α) διάμετρος μιτροειδικού δακτυλίου >3,7cm2 β) απόσταση δακτυλίου από το σημείο επαφής των γλωχίνων >11 χιλ γ) ελκτική επιφάνεια (tenting area) >1,6cm2 δ) ανεπάρκεια >3/4 A.Κρανίδης Ι.Παρασκευαίδης Η συμβολή της απεικόνισης στις καρδιαγγειακές παθήσεις, Αθηνα 2011

27 Mitral valve (MV) surgery for ischaemic mitral regurgitation MV repair in CABG patients with IMR and depressed LVEF is not superior to MV replacement with regard to operative early mortality and mid-term survival. Lio A et al. Interact Cardiovasc Thorac Surg Jul;19(1):64-9.

28 Coronary artery bypass grafting with concomitant cardiac resynchronisation therapy.eur J Cardiothorac Surg Dec;38(6): For majority of the patients with ischaemic HF and evidence of LV dyssynchrony, CABG neither eliminates dyssynchrony nor improves systolic function. Epicardial implantation of a CRT system concomitant with CABG facilitates patient management in the early postoperative D) Assessment of LEFT NENTRICUAR ASYNCHRONY period, improves LV systolic function and quality of life and is associated with low

29 Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft Cardiac resynchronization therapy (CRT) is a proven therapeutic method in selected pts with HF and systolic dysfunction which increases left ventricular function and patient survival. We showed that the increase in LVEF and pts improvement according to NYHA-class was significant in pts the with CRT-D insertion before CABG and readmission, mortality rate Ann Card Anaesth Jan-Mar;18(1):34-8. and AF was increased significantly in the doi: /

30 SPECKLE TRAKING Combined longitudinal & radial dysynchrony predicted EF response with 88% sensitivity & 80% specificitycombined longitudinal & radial dysynchrony pre J Am Coll Cardiol 2007;50 : 1476

31 4. Χαρακτηριστικά της αριστερής κοιλίας Αθανάσιος Κρανιδης-Ιωάννης Παρασκευαιδης < Απεικόνιση στην Καρδιολογία -υπό έκδοση> Δεν ανταποκρινονται στην αμφικοιλιακή βηματοδοτηση αυτοί που έχουν : 1) μεγάλο τελοδιαστολικό όγκο αριστερής κοιλίας (>25Ο ml) ή τελοδιαστολική διάμετρο της αριστερής κοιλίας ( > 7.5 cm). 2) καμμια ινότροπη εφεδρεία με την χορήγηση δοβουταμίνης ( μη αύξηση >7.5% του Κ.Ε. της αριστερής κοιλίας). 3) εκτεταμένη ούλη κυρίως στο

32 Circ Res Apr 11;114(8): Autologous mesenchymal stem cells produce concordant improvements in regional function, tissue perfusion, and fibrotic burden when administered to patients undergoing coronary artery bypass grafting: The Prospective Randomized Study of Mesenchymal Stem Cell Therapy in Patients Undergoing Cardiac Surgery (PROMETHEUS) trial. Karantalis V1, et al. Intramyocardial injection of autologous MSCs into akinetic yet nonrevascularized segments produces comprehensive regional functional restitution, which in turn drives improvement in global LV function. These findings have important therapeutic and mechanistic hypothesis-generating implications

33 ΤΕΛΟΣ EYXAΡΙΣΤΩ ΓΙΑ ΤΗ ΠΡΟΣΟΧΗ

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