ΑΜΦΙΚΟΙΛΙΑΚΗ ΒΗΜΑΤΟΔΟΤΗΣΗ

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1 ΠΑΝΕΛΛΗΝΙΑ ΣΕΜΙΝΑΡΙΑ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ 2015 ΟΜΑΔΑ ΕΡΓΑΣΙΑΣ ΚΑΡΔΙΑΚΗΣ ΑΝΕΠΑΡΚΕΙΑΣ Από τη βασική έρευνα στην κλινική πράξη ΑΜΦΙΚΟΙΛΙΑΚΗ ΒΗΜΑΤΟΔΟΤΗΣΗ Ξυδώνας Σωτήριος, MD, FESC Καρδιολογικό Τµήµα, Γ.Ν.Α. «Ο Ευαγγελισµός»

2 Δεν υπάρχει σύγκρουση συµφερόντων µε τις χορηγούς εταιρείες

3 Hemodynamic parameters COMPANION study. N Engl J Med 2004;350:

4 Hemodynamic parameters Europace 2015 Feb 06; [EPub Ahead of Print],

5 Hemodynamic parameters Europace 2015 Feb 06; [EPub Ahead of Print],

6 Mechano - Energetic efficiency Circulation 2000;102:

7 CRT: Από τη βασική έρευνα στην κλινική πράξη! Molecular Polarization! Electrophysiological changes! Regional Transcriptome! Proteomics Mitochondria! ECG Activation Maps

8 Molecular Polarization Canine model of cardiac dyssynchrony and resynchronization Circulation 2009;119:

9 Molecular Polarization CRT increases levels of endogenous inotrope APELIN Eur J Heart Fail 2007;9:

10 Molecular Polarization CRT and Inflammation Pacing Clin Electrophysiol. 2006;29:

11 Molecular Polarization CRT - Remodeling - Tenascin-C and MMP-9 Eur J Heart Fail. 2007;9:

12 Molecular Polarization Circulation. 2003;108:

13 Molecular Polarization Circulation. 2003;108:

14 Molecular Polarization Circulation. 2003;108:

15 Molecular Polarization Circulation. 2003;108:

16 Molecular Polarization Circulation. 2003;108:

17 Molecular Polarization CRT reversal of global Apoptosis and Regional Stress Kinase Activation Circulation. 2008;117:

18 CRT: Από τη βασική έρευνα στην κλινική πράξη! Molecular Polarization! Electrophysiological changes! Regional Transcriptome! Proteomics Mitochondria! ECG Activation Maps

19 APD and CRT Electrophysiological Changes APD in LV myocytes from control, DHF, and CRT hearts. A Representative superimposed APs recorded at pacing CL of 0.5, 1.0, 2.0, and 4.0s B Relationship between pacing CL and APD at 90% recovery (APD90) from anterior and lateral myocytes in each group. All data were obtained during pacing at 0.25 Hz. P0.05 vs control; #P0.05 vs DHF. ANT or A indicates anterior; LTR or L, lateral.

20 Electrophysiological Changes TNF- α prolongs APD Am J Physiol Heart Circ Physiol 2007;293:H238 H245.

21 Electrophysiological Changes TNF-α reduces I to current Am J Physiol Heart Circ Physiol 2007;293:H238 H245.

22 Electrophysiological Changes Oxidative stress, APD increase and EADs Circ Res. 2009;104:79-86.

23 Electrophysiological Changes Oxidative stress, CaMKII, I Na increase, APD prolongation, Arrhythmias J Clin Invest. 2006;116:

24 Electrophysiological Changes CRT decreases EADs Circulation. 2009;119:

25 Electrophysiological Changes CRT restores I K1, I kr, I ks, but not I to Circulation. 2009;119:

26 CRT restores I K1, I kr, I ks, but not I to Electrophysiological Changes DADs DADs Circulation. 2009;119:

27 Electrophysiological Changes CRT restores I CaT and I CaL

28 Electrophysiological Changes CRT restores I CaT and I CaL

29 CRT: Από τη βασική έρευνα στην κλινική πράξη! Molecular Polarization! Electrophysiological changes! Regional Transcriptome! Proteomics Mitochondria! ECG Activation Maps

30 Regional Transcriptome Trancriptome Circ Cardiovasc Genet. 2009;2:

31 Regional Transcriptome Trancriptome Circ Cardiovasc Genet. 2009;2:

32 Regional Transcriptome CRT restores homogeneous glucose metabolism J Am Coll Cardiol 2003;41:

33 Regional Transcriptome CRT improves G-protein signaling Summarized data for up-regulation and down-regulation of the regulator of G-protein signaling (RGS) proteins by CRT Circulation. 2009;119:

34 CRT: Από τη βασική έρευνα στην κλινική πράξη! Molecular Polarization! Electrophysiological changes! Regional Transcriptome! Proteomics Mitochondria! ECG Activation Maps

35 Proteomics Mitochondria

36 CRT improves Mitochondria Proteomics Circ Cardiovasc Genet. 2010;3:78-87

37 CRT: Από τη βασική έρευνα στην κλινική πράξη! Molecular Polarization! Electrophysiological changes! Regional Transcriptome! Proteomics Mitochondria! ECG Activation Maps

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39 Myocardial Wall Motion J Am Coll Cardiol 2007;50:

40 Survival and CMR-TSI J Am Coll Cardiol 2007;50:

41 Main CRT studies and QRS morphology Heart Rhythm,

42 Propagation Mapping ECG Activation Maps in press Heart Rhythm 2015;0:1 10

43 Electrical dyssynchrony parameters in press Heart Rhythm 2015;0:1 10

44 ECG Activation Maps CircAdapt model Europace 2014;16:iv62 iv68.

45 Effects of CRT on SV and resynchronization of viable myocardial tissue Europace 2014;16:iv62 iv68.

46 WiCS-LV technology. Myocarditis (WHO/ISFC) Circulation1996;93: Europace 2013;15:

47 Europace 2014:16:

48 NYHA, LVEF, LVEDV, LVESV Europace 2013;15:

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50 Γ.Ν.Α. «Ο Ευαγγελισµός» Σας ευχαριστώ