Interest of PVO2 assesment in HFpEF patients

Transcription

1 Interest of PVO2 assesment in HFpEF patients Jean Yves TABET CRCB, Villeneuve Saint Denis Institut Jacques Cartier, Massy

2 Conflits of interest none

3 Interest of PVO2 in HFr EF Evaluation of exercise tolerance Interest of assessing ET Prognostic evaluation Calibration of exercice training and exercise capacity improvement evaluation

4 Exercise tolerance evaluation in HFrEF Hawley : PVO2= 0,01141 x PMA+ 0,435 Mitchell SH, chest 2003

5 Koike, chest 2002

6 Muscular mass Fat O2 metabolism Oxydative capacity HFrEF Arterial compliance Endothelial dysfunction Myocytes Fibrosis Capillar density O2 consumption Exercise tolerance

7 Interest of PVO2 in HFpEF? How to assess exercise tolerance? Interest of assessing ET Prognostic evaluation Calibration of exercice training and exercise capacity improvement evaluation

8 Muscular mass Fat O2 metabolism Oxydative capacity HFpEF..? Arterial compliance Endothelial dysfunction Myocytes Fibrosis Capillar density O2 consumption Exercise tolerance

9 17 controls 31 HTN 22 HTN+HFpEF Myocardial biopsy per CABG Myocardial alterations in HFpEF 124 HFpEF vs 104 controls Autopsy study Zile MR circulation 2015 Mohammed SF, circulation 2015

10 14 controls, 15 HFrEF 16 HFpEF Echo d effort + CPX Shimiaie J, J Am Coll Cardiol HF 2015

11 Skeletal muscular alterations in HFpEF Lateral vastus muscle biopsy 22 HFpEF 70±7 years vs 43 matched controls 63 HFpEF 69±7 years vs 15 matched controls Kitman DW Am J of Physiol Heart Circ Physiol 2014 Haykowsky MJ Am J Cardiol 2014

12 Vascular alterations in HFpEF Farrero M, Circ Heart Fail 2014 Tartiere L, Jam Coll Cardiol 2012

13 48 HFrEF, 56 HFpEF, 24 controls CPX+ invasive hemodynamic monitoring Dhakal BP, Circ Heart Fail 2015

14 Muscular mass Fat O2 metabolism Oxydative capacity HFpEF Arterial compliance Endothelial dysfunction Myocytes Fibrosis Capillar density O2 consumption Exercise tolerance

15 CPX and HCM 135 consecutive patients with hypertrophic Sharma S. Am J Cardiol 2000;86:

16 Exercice capacity in HFpEF Dhakal BP, Circ Heart Fail 2015

17 Interest of PVO2 in HFpEF? How to assess exercise tolerance? Interest of assessing ET Prognostic evaluation Calibration of exercice training and exercise capacity improvement evaluation

18 The Safety of Cardiopulmonary Exercise Testing in a Population With High- Risk CV Diseases 5060 tests HCM 700 CPX is generally a safe procedure, even in a population with underlying high-risk cardiovascular diagnoses. Skalski J. Circulation. 2012;126:

19 Pauci symptomatic HCM patients with LVOT 182 patients (mean age years; 65% men) symptoms Follow-up (mean years) Sorajja P. Am J Cardiol 2012;109:

20 156 HCM 27% LVOT at rest 35% effort follow-up 27± 1 1months Composite outcome - cardiac-related death, - heart transplant, -functional deterioration leading to septal reduction therapy) peak VO2 <80% VE/VCO2 slope >34 Left atrial volume index Finocchiaro. J Am Coll Cardiol HF 2015;3:408 18)

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22 The Role of Exercise Testing in the Evaluation of the Patient with Hypertrophic Cardiomyopathy Firoosi. Current Cardiology Reports 2001, 3:

23 Prognostic value of exercise tolerance inhfpef CPX and 6 min walk test in HFrEF (56 patients) and HFpEF( 48 patients) Cahalin LP, Eur J Heart Fail 2013

24 Interest of PVO2 in HFr EF Evaluation of exercise tolerance Prognostic evaluation Calibration of exercice training

25 Pandey A, circ Heart Fail 2015

26 Pandey A, circ Heart Fail 2015

27 CONCLUSION Interest of PVO2 in HFpEF? assess exercise tolerance? Interest of assessing ET Prognostic evaluation Calibration of exercice training and exercise capacity improvement evaluation

28 Dhakal BP, Circ Heart Fail 2015

29 48 HFrEF, 56 HFpEF, 24 controls CPX+ invasive hemodynamic monitoring Dhakal BP, Circ Heart Fail 2015

30 Prognostic value of exercise tolerance inhfref CPX and 6 min walk test in HFrEF (56 patients) and HFpEF( 48 patients) Cahalin LP, Eur J Heart Fail 2013

31 Haykowsky MJ, J Am Coll Cardiol 2011

32 fiber I vs II ratio and fiber density in diaphragm and soleus in control and HRpEF rats Dhakal BP, Circ Heart Fail 2015

33 Tribouilloy C, Eur Heart J 2008

34 48 HFPEF patients (age 69±6 years) and 25 healthy age-matched controls (HC) Stress echo+cpx Haykowsky MJ, J Am Coll Cardiol 2011

35 HCM and CPX

36 Shimiaie J, JACC HF controls, 15 HFrEF 16 HFpEF Echo d effort + CPX

37 Predictors of long-term outcomes in patients with hypertrophic cardiomyopathy undergoing cardiopulmonary stress testing and echocardiography 1,005 HCM patients (50 ± 14 years, 64% men, 77% on β-blockers). End point was a composite of death, appropriate defibrillator discharges, resuscitated sudden death, stroke, and heart failure admission. Masri A. Am Heart J 2015;169:

38 1653 patients with HCM and EF 50% stratified according to quartiles of quartiles of peak oxygen consumption (peak V O2) and VE/VCO2 slope. Caroline J. Coats et al. Circ Heart Fail. 2015;8:

39 48 HFrEF, 56 HFpEF, 24 controls CPX+ invasive hemodynamic monitoring Dhakal BP, Circ Heart Fail 2015