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Daniela Miani Dipartimento di scienze Cardiopolmonari Ospedale Universitario, Udine

Omogeneizzazione dei percorsi: dal caso clinico alla Flow-Cart: Scompenso Cardiaco ad FE conservata. Daniela Miani Dipartimento di scienze Cardiopolmonari Ospedale Universitario, Udine . 14 Marzo 2009, Palmanova. Scompenso cardiaco ad FE conservata.

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Daniela Miani Dipartimento di scienze Cardiopolmonari Ospedale Universitario, Udine

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  1. Omogeneizzazione dei percorsi: dal caso clinico alla Flow-Cart:Scompenso Cardiaco ad FE conservata Daniela Miani Dipartimento di scienze Cardiopolmonari Ospedale Universitario, Udine 14 Marzo 2009, Palmanova

  2. Scompenso cardiaco ad FE conservata 3 condizioni obbligatorie devono essere soddisfatte: • presenza di segni o sintomi di scompenso cardiaco • presenza di funzione sistolica ventricolare sinistra normale o lievemente ridotta (LVEF>45-50%) • evidenza di disfunzione diastolica ventricolare sinistra (abnorme rilasciamento,riempimento, distensibilita’ diastolica e stifness) Paulus Eur Heart J 2007;28:2539-50

  3. HFNEF: Diagnosi differenziale Maeder J Am Coll Cardiol 2009;53;905-918

  4. Flow chart per la diagnosi di scompenso cardiaco con i peptidi natriuretici Eur Heart J 2008;29(19):2388-442

  5. Concentrazioni del BNP in pazienti con FE normale, disfunzione VS sistolica, disfunzione VS diastolica e combinate Maisel AS et al. Am Heart J 2001;141:367-74

  6. Paulus Eur Heart J 2007;28:2539-50

  7. Nagueh et al. J Am Soc Echo 2009;22:108-33

  8. Nagueh et al. J Am Soc Echo 2009;22:108-33

  9. HFNEF diagnosi Sintomi e/o segni di SC Rx torace, ECG NT-proBNP>220pg/ml o BNP>200pg/ml Funzione sistolica ventricolare sn normale o leggermente ridotta (>50%) VTDVS<97ml/m2 Atrio sn grande>34 ml/m2 E/e’ medio (setto-parete laterale)/2>12 cm/s NO SI HFNEF 8< Normale 8-12 Vene polmonari Ar-A>30 ms NO SI Altro HFNEF

  10. Class I 1. Physicians should control systolic and diastolic hypertension in patients with HF and normal LVEF, in accordance with published guidelines. (Level of Evidence: A) 2. Physicians should control ventricular rate in patients with HF and normal LVEF and atrial fibrillation. (Level of Evidence: C) 3. Physicians should use diuretics to control pulmonary congestion and peripheral edema in patients with HF and normal LVEF. (Level of Evidence: C)

  11. Trial randomizzati nello scompenso cardiaco HFPEFHFNEF CHARM Preserved DIG Ancillary SWEDIC SENIORS PEP CHF ALLHAT I-PRESERVE HONG KONG TOPCAP (ongoing) CONSENSUS VHEFT I e II SOLVD SAVE DIG RADIANCE PROVED PRIME I e II VEST PROMISE PROFILE PICO AIRE TRACE ELITE I e II ANZ MDC PRAISE US CARVEDILOL BEST CIBIS II RALES MERIT HF COPERNICUS CAPRICORN VALHEFT COMET CHARM A lt+ Add

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