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Master Thesis

Myocardiopathies à coronaires saines ayant présenté des troubles du rythme ventriculaire : évaluation de la prise en charge diagnostique

Abstract : Background: Non ischemic dilated cardiomyopathies constitute a wide group of cardiac diseases, which do not have an identical evolution and outcome. The diagnosis of non ischemic dilated cardiomyopathy is usually based on the results of a trans-thoracic echocardiogram (TTE) and a coronary angiography. Knowledge of their specific etiology may allow physicians to ensure specific care for patients, in particular for those suffering from ventricular arrythmias. However, a specific and more precise diagnosis is not often searched for. Aims : The objective of this study is to assess the paraclinical evaluation carried out for patients suffering from non ischemic dilated cardiomyopathy complicated by ventricular arrythmias in a tertiary care center. The role and contribution of each test will be discussed. Methods: Every patient suffering from a non ischemic dilated cardiomyopathy and referred to Bordeaux's university for the management and evaluation of ventricular arrythmias - ventricular tachycardia ablation or implantable cardioverter defibrillator implantation - between 2007 and 2014 were included. Data concerning demographic characteristics, medical tests performed, ventricular arythmia recurrence and outcome were collected. We tried to assess the usefulness of additionnal tests for the diagnosis of non ischemic dilated cardiomyopathies. Results: 135 adult patients were enrolled, with a 39 ± 26 months follow-up. Every patient had a TTE and a coronary angiography, 46.7% of them had a MRI-scan, 34.8% had a CT-scan, 15.6% had a genetic testing, 1.5% had a PET-scan, and 0.7% had a heart biopsy. Performing additionnal tests (besides TTE and coronarography) was useful in 40% of our patients: it changed the diagnosis in 4% of cases and allowed the physician to make a specific diagnosis in 36 % of cases. Over the study period, we observed a significant increase of the number of MRI-scans and CT-scans performed, evidence of a change of practices. However 24% of patients had no additional tests performed and were diagnosed a non ischemic dilated cardiomyopathy by default. Conclusions: Despite a change in practices over the past years, not all patient suffering from non ischemic dilated cardiomyopathy are given the opportunity of additional investigations in order the search for a specific diagnosis. Yet, these tests are often valuable, and the knowledge of the specific etiology can lead to a better patient care and to an early family screening.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01199749
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Wednesday, September 16, 2015 - 10:07:31 AM
Last modification on : Wednesday, August 23, 2017 - 4:29:55 PM
Long-term archiving on: : Tuesday, December 29, 2015 - 7:26:16 AM

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Prune Gaillard. Myocardiopathies à coronaires saines ayant présenté des troubles du rythme ventriculaire : évaluation de la prise en charge diagnostique. Médecine humaine et pathologie. 2015. ⟨dumas-01199749⟩

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