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Master Thesis

Obstruction microvasculaire post-infarctus : effet sur la fonction diastolique et la réponse à l'activité physique

Abstract : BACKGROUND: Microvascular obstruction (MVO) provides systolic dysfunction and left ventricular remodeling, impairing post-infarction prognosis. The aim of our study was to determine the effect of MVO on diastolic function, exercise capacity and recovery after cardiac rehabilitation. METHODS: 47 patients who underwent a rehabilitation program for myocardial infarction (STEMI) were included. MVO was visually quantified by cardiac magnetic resonance (CMR), diastolic function and exercise capacity were assessed by echocardiography and cardiopulmonary exercise testing (CPX) before and after rehabilitation. The patients were divided into 2 groups according to MVO severity. RESULTS: In patients with severe OMV, diastolic function was impaired with a decreased lateral e’ wave (p = 0.04), an increased E/A (p = 0.05), lateral E/e’ (p <0.0001) and BNP (p = 0.002). Exercise capacity was impaired with an increased VE/VCO2 slope (p = 0.0009) and a decreased oxygen pulse (p = 0.002). The oxygen uptake peak (VO2 peak) was not significantly altered (p = 0.3) and its recovery (p <0.0001), as well as peak work rate recovery (p <0.0001) and BNP recovery (p = 0.004) were not limited by MVO. Diastolic function after rehabilitation remained impaired in MVO patients who had more third grade diastolic dysfunction (p = 0.04) and increased lateral E/e’ (p = 0.003). After multivariate analysis, the association between severe MVO and lateral E/e’ >10 was the only which persisted regardless of LVEF (p = 0.0496). Systolic function (LVEF) was more impaired in the presence of MVO before and after rehabilitation (respectively (p = 0.004) and (p = 0.008)). DISCUSSION: After myocardial infarction, MVO is associated with impaired diastolic function and exercise capacity but does not limit the after rehabilitation recovery. These results do not appear to be independent of the LVEF.
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Rébecca Codiat. Obstruction microvasculaire post-infarctus : effet sur la fonction diastolique et la réponse à l'activité physique. Cardiologie et système cardiovasculaire. 2017. ⟨dumas-01787666⟩

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