ai sensi dell art. 76 comma 4 dell Accordo Stato-Regioni del 2 febbraio 2017 e in accordo con il Codice Etico della SIMI dichiara

Transcription

1 Il sottoscritto Francesco Perticone ai sensi dell art. 76 comma 4 dell Accordo Stato-Regioni del 2 febbraio 2017 e in accordo con il Codice Etico della SIMI dichiara per l evento in oggetto l esistenza negli ultimi due anni di rapporti di natura finanziaria e lavorativa con le seguenti imprese commerciali operanti in ambito sanitario:

2 Università Magna Græcia di Catanzaro Dipartimento di Scienze Mediche e Chirurgiche Cattedra e Scuola di Specializzazione in Medicina Interna Prof. Francesco Perticone Lo Scompenso Cardiaco perticone@unicz.it

3 Heart failure is a multisystem disorder which is characterized by abnormalities of: cardiac skeletal muscle renal function stimulation of the SNS complex pattern of neurohormonal changes

4 Heart failure is a multisystem disorder which is characterized by abnormalities of: cardiac skeletal muscle renal function stimulation of the SNS complex pattern of neurohormonal changes

5

6

7 Tan YT et al, J Am Coll Cardiol 2009;54:36-46

8

9 Owan TE et al, N Engl J Med 2006;355:251-9

10 Suggested pathophysiological mechanisms predisposing to the development of diastolic function and heart failure in otherwise healthy ageing hearts Lazzarini V et al Eur J Heart Fail 2013;15:717-23

11 Heart failure is a multisystem disorder which is characterized by abnormalities of: cardiac skeletal muscle renal function stimulation of the SNS complex pattern of neurohormonal changes

12

13 As heart failure advances, the RAAS and SNS become the predominantly activated neurohormonal systems NP system NPRs NPs Vasodilation Blood pressure Sympathetic tone Natriuresis/diuresis Vasopressin Aldosterone Fibrosis Hypertrophy Inactive fragments HF SYMPTOMS & PROGRESSION ANG=angiotensin; AT1R=angiotensin type 1 receptor; NP=natriuretic peptide; NPRs=natriuretic peptide receptors; RAAS=renin-angiotensin-aldosterone system; SNS=sympathetic nervous system Levin et al. N Engl J Med 1998;339:321 8; Nathisuwan & Talbert. Pharmacotherapy 2002;22:27 42; Kemp & Conte. Cardiovascular Pathology 2012; ; Schrier et al. Kidney Int 2000;57: ; Schrier & Abraham N Engl J Med 2009;341:577 85; Boerrigter, Burnett. Expert Opin Invest Drugs 2004;13:643 52; Ferro et al. Circulation 1998;97: ; Brewster et al. Am J Med Sci 2003;326:15 24 Epinephrine Norepinephrine Ang II SNS α 1, β 1, β 2 receptors Vasoconstriction RAAS activity Vasopressin Heart rate Contractility RAAS AT 1 R Vasoconstriction Blood pressure Sympathetic tone Aldosterone Hypertrophy Fibrosis Sodium and water retention

14 Adrenergic Receptor Densities in Human LV Myocardium Receptor Density (fmol/mg) Non-failing Failing (IDC) * * 10 0 ß 1 ß 2 1 * P < 0.05 vs. non-failing IDC = Idiopathic Dilated Cardiomyopathy Bristow MR et al. Clin Drug Ther 1989

15 Hyponatreemia in CHF Urso C et al, Heart Fail Rev 2015;20:

16 Pathogenesis and effects of hypokalemia in CHF Urso C et al, Heart Fail Rev 2015;20:

17 Metabolic alkalosis in CHF Urso C et al, Heart Fail Rev 2015;20:

18 Pathogenesis and effects of hypomagnesemia in CHF Urso C et al, Heart Fail Rev 2015;20:

19

20 Possible Sequence of Events Involved in the Pathogenesis of HF in Chronic Severe Anemia

21 Anaemia and Mortality in HF Patients Data from 34 selected studies on 153,180 patients Prevalence of anemia: 37,2% Crude mortality: Anaemic patients: 48,8% Nonanaemic patients: 29,5% (unadjusted mortality risk: 1.9 (CI , p <0.001) The mortality risk associated with the presence of anaemia is not significantly different between patients with systolic CHF and diastolic CHF Hessel F et al. J Am Coll Cardiol 2008, 52:818

22 Sideremia, mcg/dl

23 ACE activity ACE Activity in HF Plasma Tissue Control Acute Compensated Decompensated Heart Failure, clinical status

24 % Survival EVENTI 100 ESV < 55 ml 90 ESV > 55 ml FE > 50% Fase acuta Rimodellamento precoce tardivo ESV < 95 ml ESV > 95 ml FE = 40-50% ESV < 130 ml ESV > 130 ml FE < 40% White, Circulation 1987

25 Heart failure is a multisystem disorder which is characterized by abnormalities of: cardiac skeletal muscle renal function stimulation of the SNS complex pattern of neurohormonal changes

26 Type-2 CRS Type-4 CRS

27

28 Heart failure is a multisystem disorder which is characterized by abnormalities of: cardiac skeletal muscle renal function stimulation of the SNS complex pattern of neurohormonal changes

29 Biological role of contraction-induced interleukin (IL)-6. Pedersen B K J Appl Physiol 2009;107: by American Physiological Society

30 Serum irisin concentration in young and old young Sprague- Dawley male rats with and without water exercise Aydin S et al, Peptides 2014;52:68-73

31 Wong LSM et al. Heart Fail Rev 2010;15:479-86

32

33

34 Insulin Resistance Ungvari Z et al, J Gerontol A Biol Sci Med Sci

35

36 Change in Cardiac Energy Metabolism in Heart Failure Neubauer S, N Engl J Med 2007;356:

37

38 Cardiovascular comorbidities Noncardiovascular comorbidities Hypertension (42-64%) Coronary artery disease Peripheral artery disease (15 20%) Cerebrovascular disease Arrhythmias Valvular heart disease Respiratory Chronic obstructive pulmonary disease Sleep-disordered breathing Endocrine comorbidities Thyroid disorders Diabetes mellitus Metabolic and nutritional Hyperlipidemia Obesity Renal dysfunction Gout Hematopoietic Anemia Neurological Cognitive dysfunction Depression Muscoloskeletal Osteoarthritis and osteoporosis Cancer

39 N=3226 HF outpatients Il 74% dei pts con HF hanno almeno 1 comorbilità van Deursen VM et al Eur J Heart Fail 2014

40 van Deursen VM et al Eur J Heart Fail 2014 Comorbidities and all cause mortality 0 comorbidities 1-3 comorbidities >3 comorbidities All cause mortality Comorbidities and heart failure hospitalization 0 comorbidities 1-3 comorbidities HF hospitalization >3 comorbidities

41 Association between beta-blockers and all-cause mortality in patients with chronic obstructive pulmonary disease in observational cohort studies > pts, retrospective cohort studies 31% Etminan et al. BMC Pulmonary Medicine 2012