Skip to Main content Skip to Navigation
Master Thesis

Échographie cardiaque et strain 3D : analyse du remodelage ventriculaire droit dans l’hypertension artérielle pulmonaire associée aux cardiopathies congénitales

Abstract : Introduction: the prognostic value of the standard ultrasound parameters of the right ventricle (RV) in pulmonary arterial hypertension (PAH) remains limited because of the RV geometry that is difficult to appreciate in 2D. Several studies have shown a better prognosis of PAH associated with congenital cardiopathy, in relation to an uncorrected cardiac shunt. In parallel, the cardiac modeling of three-dimensional ultrasound images (3D), as well as the analysis of myocardial deformation by speckle tracking, are new validated study tools in pulmonary hypertension. Objective: we sought to highlight the differences in RV deformation in 3D echocardiography of patients with PAH associated with congenital heart disease, compared to patients with PAH of different etiology, as well as a control group; and to study the prognostic value of 3D RV deformation on these patients. Methods: we conducted a prospective multicentric cohort study from June 2015 to June 2017. Patients included were subjects with catheter-confirmed PAH associated with congenital heart disease (PAH-CHD) or other etiology. group 1 (non-CHD PAH). Patients with complex congenital heart disease and non-echogenic patients were excluded. Patients benefited of an echocardiogram with 3D image acquisition on the right ventricle. The 3D loops were then processed by the TomTec 4D RV-Function software (TomTec imaging systems) and the resulting VD meshes were post-processed to extract and compare the regional deformation data. Results: we included 27 in the PAH-CHD group, compared to 27 in the non-CHD PAH group, as well as 27 healthy controls, matched for age and sex. Most of global and regional 3D strain measurements were significantly lower in patients compared to controls. Overall circumferential 3D strain was better in patients with PAH-CC (-13.55% vs. 3.56 vs. -10.82% vs. 3.89, p = 0.006), as did 3D FEVD (42.30% vs. 10.74% vs. 9.02%, p = 0.002). The global circumferential 3D strain, the right ventricular end-diastolic volume and the 3D FEVD were found as independent survival prognostic factors. Conclusion: RV remodeling differs between patients with PAH associated with congenital heart disease and patients with PAH of other etiology. A better RV circumferential deformation in patients with PAH-CHD could explain their favorable prognosis.
Complete list of metadatas

Cited literature [116 references]  Display  Hide  Download

https://dumas.ccsd.cnrs.fr/dumas-02447389
Contributor : Médecine Ub <>
Submitted on : Tuesday, January 21, 2020 - 3:35:46 PM
Last modification on : Saturday, February 8, 2020 - 1:24:13 AM
Long-term archiving on: : Wednesday, April 22, 2020 - 7:10:29 PM

File

 Restricted access
To satisfy the distribution rights of the publisher, the document is embargoed until : 2020-10-12

Please log in to resquest access to the document

Identifiers

  • HAL Id : dumas-02447389, version 1

Collections

Citation

Nicolas Dursent. Échographie cardiaque et strain 3D : analyse du remodelage ventriculaire droit dans l’hypertension artérielle pulmonaire associée aux cardiopathies congénitales. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02447389⟩

Share

Metrics

Record views

28