Predicting Failure Hemodynamics as Energetics.pptx

1、Predicting Failure:Hemodynamics as Energetics,Jonathan Grinstein,MD,FACCDirector of Mechanical Circulatory SupportDirector of Research,Advanced Heart FailureAssociate Professor of Medicine,University of Chicago,Predicting Patient Trajectory and Response to Therapy is Challenging,Each Patient has a U

2、nique Trajectory,Pt 1,Pt 2,Pt 3,Defining the Next Best Therapy Isnt Always Clear,Prognostic ToolsThe Eternal Debate,Our Current Tools Are Limited and Ineffective,Standard Hemodynamic Assessment:Represents the final pressure and flow output of the heartDoesnt immediately answer the question“how or wh

3、y?”the heart is failing,Advanced Hemodynamics and Energetics:More complete physiologic AssessmentReflect the tunable drivers/processes of heart performanceMechanistically tied to recovery and/or disease progression?,Energetics,The Eternal Debate Do We Finally Have A Winner?,=,=,CPO=SW x HRAPI=(SBP-D

4、BP)/PCWP,Advanced Hemodynamic Parameters,Cardiac Power Output,451,=,Represents the energy output of the heart per unit time,CPO Is Prognostic but it Depends on the Circumstances,SHOCK Trial:CPO Highly Prognostic in MI-CS,CSWG Registry:CPO not Prognostic(All Comers CS),Fincke R et al.JACC.2004.44(2):

5、340-8Thayer KL et al.Circ Heart Fail.2020.13(9):e007099.,Aortic Pulsatility Index,API=,Reflects the input/output relationship of the heart(i.e.Starling relationship)and thus efficiency,Grinstein et al.Manuscript pre-submission,Aortic Pulsatility Index Prognostic Across the Entire Clinical Spectrum,A

6、CC/AHA Stage B and C,ACC/AHA Stage B and C,ACC/AHA Stage C and DSCAI Stage C,Acute MI Cardiogenic Shock,Belkin/Grinstein et al.ESC HF.2021.8(2):1522-30Deis/Gustafsson et al.Card Fail Rev.2022.16:8:e18,Belkin/Grinstein et al.JCF.2021.27(10):1045-52Sudermeyer/Burkhoff/Kapur et al.Currently Submitted.,