Échoscopie cardiaque en médecine générale : évaluation de paramètres hémodynamiques pour le suivi des patients insuffisants cardiaques

Abstract : Introduction: Heart failure is a public health issue with high prevalence and high mortality. Echocardiography is the keystone of its management, both for diagnosis and follow-up. General practitioners, gradually appropriating the ultrasound tool according to the concept of point-of-care ultrasound, or echoscopy, could use it for cardiological purposes to improve the management of patients with heart failure on the first line. The objective of our study was to propose a cardiac echoscopy protocol for general medicine. Material and method: First, we identified echoscopic criteria that are decisive for the management of heart failure in general practice. To this end, we conducted an opinion survey whose results were compared with data from the literature. This allowed us to establish a cardiac echoscopy protocol for general medicine. We then tested this protocol by comparing the data measured by a general practitioner with those of a cardiologist. Results: 23 physicians were interviewed to perform the cardiac echoscopy protocol. The main criteria used in general practice were left ventricular ejection fraction (LVEF), assessed visually and using the Mitral Annular Plane systolic excursion (MAPSE), left ventricular filling pressures (LVFP) assessed by mitral doppler and mitral tissue doppler, left atrium surface (LAS) and inferior vena cava dimensions (IVC). The agreement between generalist and cardiologist was good for LVEF (k = 0.69), LVFP (k = 0.62) and IVC (k= 0.64). It was moderate for LAS (k= 0.52). Conclusion: The use of cardiac echoscopy in general practice seems easily achievable when it is standardized and after a short training period. A practical sheet is available to general practitioners to facilitate its production.
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Submitted on : Monday, April 8, 2019 - 9:42:53 AM
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Alexis Leger. Échoscopie cardiaque en médecine générale : évaluation de paramètres hémodynamiques pour le suivi des patients insuffisants cardiaques. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02092356⟩

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