Joint Symposium with the ESC: The pulmonary circulation in the heart failure syndrome

23 June 2021

  • days
  • Hours
  • Minutes

Chair and moderators

Sophia Airhart, University of Arizona College Of Medicine, USA

Michele D'Alto, Monaldi Hospital, Italy

George Giannakoulas, Ahepa University Hospital, Greece

 

Agenda

  • Marco Guazzi // The right ventricle in HFpEF
  • Mark Toshner // genetic aspects in group2 PH
  • Gabor Kovacs // Exercise haemodynamics in heart failure: what can we learn from invasive CPET?
  • Stephan Rosenkranz // Systemic consequences and interorgan cross-talk in heart failure and PH
  • Vineet Agrawal // The natriuretic peptide Clearance receptor selectively causes right ventricular dysfunction in a model of pulmonary hypertension and heart failure with preserved ejection fraction
  • Swathi Veeroju // N-Lysine methyltransferase Smyd2-mediated HIF-1A stabilization plays a protective role in RV hypertrophy

A deeper look

In patients with left ventricular heart failure, the development of pulmonary hypertension (PH) and right ventricular dysfunction are frequent since pulmonary hypertension related to left heart disease by far represents the most common form of PH, accounting for 65–80 % of cases.  The development of this disease has an important impact on morbidity and mortality of patients, and therefore clinical attention is warranted. The pathophysiology of PH-LHD is complex and believed to be the result of the effects of hydrostatic pressure on pulmonary vascular remodelling.

"The Joint Symposium with the ESC: The pulmonary circulation in the heart failure syndrome“ will take a closer look at the role of the right ventricle in patients with HFpEF and highlight systemic consequences and interorgan cross-talk in heart failure and PH. Furthermore, genetic aspects in patients with PH related to left heart disease will be discussed. Since invasive cardiopulmonary exercise testing (CPET) offers a wealth of information about a patient’s functional status and hemodynamics, diagnostic assessment in patients with heart failure will also play a central role in the content of the symposium. Finally, best abstract presentations will discuss new basic science data on the role of the natriuretic peptide clearance receptor in the development of right ventricular dysfunction and the protection of right ventricular hypertrophy by N-lysine methyltransferase Smyd2-mediated HIF-1A-stabilization. All these topics will be presented by world-renowned experts in the field of pulmonary hypertension.

In summary, the symposium will present both current scientific data and clinically relevant aspects of the most common form of PH and thereby provides insights for a better understanding of disease pathogenesis and therapeutic implications in clinical practice.

 

The right ventricle in HFpEF

15:00-15:15 BST

Presenter: // Marco Guazzi, University of Milan, Italy

HFpEF is a complex disease at high and increasing prevalence with no effective therapeutic options. Among the pathophysiologic abnormalities that contribute to the heterogeneity of HFpEF syndrome recent epidemiological and clinical studies have progressively focused on the right heart (RH), pointing out its basic role as a mediator of the progression of the disease; exhibiting a high prediction value for clinical worsening and representing a main target of newly developed therapeutic opportunities. Several clinical RH phenotypes at rest and during physical challenge have been described and the pathophysiology behind the different evolving stages is a matter of intriguing investigation. The main reason for the development of RH dysfunction is the augmented load imposed by the increased left atrial pressure associated with LV diastolic dysfunction and atrial myopathy yielding to an increased pulsatile loading. The development of pulmonary vascular disease and wall remodeling further exacerbates the RH impedance through an increase in resistive load.

The gold standard for measuring RH systolic function and its coupling with pulmonary circulation is the analyses of cardiac and vascular elastances by pressure-volume loops but a number of echocardiography-derived parameter are used in daily practice for acquiring either functional and morphological information. Although these measures reflect, only in part, the complex hemodynamic adaptations of the RH, the functional assessment is now comprehensively approached throughout advanced imaging along with simplified method for RV to PC coupling. These indicators demonstrate a remarkable prognostic value starting from earlier stages of the disease. Based on this evidence most of the future research should focus on how the study of RH phenotypes could implement our knowledge on HFpEF.

 

Genetic aspects in group2 PH

15:22-15:37 BST

Presenter: // Mark Toshner, University of Cambridge, UK

Awaiting further information 

 

Exercise haemodynamics in heart failure: What can we learn from invasive CPET?

15:45-16:00 BST

Presenter: // Gabor Kovacs, Medical University of Graz, Austria

Awaiting further information

 

Systemic consequences and interorgan cross-talk in heart failure and PH

16:08-16:23 BST

Presenter: // Stephan Rosenkranz, University of Cologne, Germany

Awaiting further information

 

Best abstract: The natriuretic peptide Clearance receptor selectively causes right ventricular dysfunction in a model of pulmonary hypertension and heart failure with preserved ejection fraction

16:30-16:40 BST

Presenter: // Vineet Agrawal, Vanderbilt University Medical Centre, USA

 

Best abstract: N-Lysine methyltransferase Smyd2-mediated HIF-1A stabilization plays a protective role in RV hypertrophy

16:45-16:55 BST

Presenter: // Swathi Veeroju, Justus-Liebig University, Giessen, Germany

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