Évaluation et survenue d'événements cardio-vasculaires chez les patients de plus de 65 ans dyspnéiques présentant une dysfonction diastolique aux urgences

Abstract : OBJECTIVES. The primary objective of this study is to evaluate the frequency and severity of diastolic dysfunction among dyspneic patients over 65 years within the Emergency Department of the CHU de la Timone in France. The occurrence of cardiovascular complications was also assessed during their hospitalization. METHODS. In this retrospective, observational, non-invasive and mono-centric study, 160 dyspnoeic patients over 65 years old were included. These patients underwent echocardiography performed by a senior emergency aid doctor, with a visual evaluation of LVEF followed by checks of diastolic function using E and e’ measurements. The occurrence of cardiovascular events during the following hospitalization was evaluated using the patient’s record. The primary outcome was the incidence of diastolic dysfunction with preserved LVEF in patients over 65 years old presenting to the Emergency room for dyspnea. The secondary endpoints were the occurrence of one or more cardiovascular events during the patient's hospitalization based on the presence or absence of diastolic dysfunction, and then the correlation between occurrence of an event and diastolic dysfunction gradation. RESULTS. Of the 128 patients analyzed, 44 patients (34%) had diastolic dysfunction with preserved LVEF. 34 cardiovascular events occurred in the group with diastolic dysfunction, versus 7 events in the group without dysfunction (p = 0.008). These events affected 24 patients in the dysfunction group (55%) versus 6 patients in the no-dysfunction group (p = 0.004, OR = 4.8 95% CI [1.64-14.04]). The analysis of the event’s occurrences in the Grade 1 versus Grade 2 and 3 groups found an OR of 2.9 [0.5 - 17.6] (p = 0.02) for Grade 2 and a OR of 56 [4.3 - 719.2] ( p = 0.02) for Grade 3. CONCLUSION. More than one third of the patients included have diastolic dysfunction, and half of this subpopulation has at least one cardiovascular event during their hospitalization, with a higher risk if they are Grade 3.
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Hélène Rousselon. Évaluation et survenue d'événements cardio-vasculaires chez les patients de plus de 65 ans dyspnéiques présentant une dysfonction diastolique aux urgences. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01971946⟩

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