HFpEF, AFib and Atrial-S...

Metadata

• Author: @CaravitaSergio on Twitter
• Full Title: HFpEF, AFib and Atrial-S...
• Category: #tweets
• URL: https://twitter.com/CaravitaSergio/status/1633673387489869825

Highlights

• HFpEF, AFib and atrial-secondary tricuspid regurgitation (A-STR) – a quite complex puzzle
  But what's the impact of atrial-STR on 🚴‍♀️hemodynamics and CPET in HFpEF ?
  A 🧵
  (View Tweet)
• But... some background, first!
  1. HFpEF is linked to AFib
  2. AFib promotes atrial-secondary TR...
  3. ...especially in HFpEF! (View Tweet)
• 1. HFpEF is linked to AFib:
  • Loss of LA contraction -> ⬆️LAP to fill LV 10.1161/01.cir.24.2.267
  • AFib -> 3 points in the H2FPEF score! 10.1161/CIRCULATIONAHA.118.034646
  • AFib and HFpEF as two sides of LA failure 10.1016/j.jacc.2019.11.013
    
    
    (View Tweet)
• 2. AFib promotes atrial-secondary TR!
     Several landmark papers by @denisamuraru @lpbadano
     https://t.co/BlsKzJDdld
     https://t.co/faokcqcSyU
     https://t.co/UXtgTfHMu7
     ...
     TA remodeling with AFib:
     TA is mostly made of fat ➡️prone to dilate when ↑ Volume / Pressure
     
     
     (View Tweet)
• 3. ...especially in HFpEF!
     @yreddyhf & @EchoLab_Gunma @MayoClinicCV demonstrated volume overload, bi-atrial remodeling and TR after development of AFib in HFpEF
     10.1016/j.jacc.2020.07.009
     10.1093/eurheartj/ehy809
     (View Tweet)
• Now, what is the impact of A-STR on hemodynamics and CPET in HFpEF?
  https://t.co/LB3iiVWXvQ
  12 HFpEF with A-STR
  vs
  1:1 age/sex/BMI-matched HFpEF-controls
  Age 72, ♀️92%, BMI 28
  AFib:
  83% HFpEF-STR
  8% of HFpEF-controls
  Bi-atrial volume larger in HFpEF-STR (LA +43%, RA +84%)
  (View Tweet)
• 🚴‍♀️hemodynamics and CPET of
  HFpEF-STR vs HFpEF-controls:
  ⬇️ CO (rest & exercise)
  compensatory ⬆️ in peripheral extraction
  (similar VO2!)
  (View Tweet)
• ↓ effective SV (due to tricuspid regurgitant volume)
  ➡️compensatory ↑ in HR
  ➡️pulmonary vascular underfilling? (inverse relationship between PVR and SV)
  (View Tweet)
• ↓ effective SV (due to tricuspid regurgitant volume)
  ➡️lower than expected increase in PAWP and LVTPM (LV/LA underfilling), further favored by ↑↑ RAP with ventricular interaction
  (View Tweet)
• That’s it.
  A-STR in HFpEF = afterload independent right heart failure with:
  i) ↓ SV and CO reserve (reliance on HR & peripheral extraction to maintain VO2)
  ii) slight ↑ PVR (pulmonary vascular underfilling)
  iii) ↓ than expected PAWP raise on exercise (LV underfilling)
  (View Tweet)
• @cla_baratto @DavideSoranna @gavazzoni_mara @Fraheilbron @michetomaselli @noela_radu @fpperelli @jeanlucvachiery @GParati22 @lpbadano @denisamuraru (View Tweet)
• Must acknowledge:
  many findings elegantly described in 2014 by Barry Borlaug & @mjandersenMD, albeit not specifically focused on HFpEF (just TR vs controls)
  10.1161/CIRCHEARTFAILURE.114.001575
  and more recently in HFpEF-STR vs amyloid cardiomyopathy
  10.1186/s12872-021-02094-3
  
  
  (View Tweet)