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Master Thesis

Infarctus et coronaropathie concomitante dans un contexte de cardiopathie dilatée : prévalence et caractérisation

Abstract : Introduction: The phenotypic characteristics of bystander infarction and bystander coronary artery disease (CAD) in dilated cardiomyopathy were currently poorly known. Results : We have identified the consecutive patients with LVEF <50% who underwent CMR and coronary angiography (CA). Patients were classed in 6 groups according to Assomull et al.: 1 =true dilated cardiomyopathy, 2 =true ischemic cardiomyopathy, 3=dilated cardiomyopathy with bystander infarction, 4=dilated cardiomyopathy with bystander CAD, 5=ischemic cardiomyopathy with no CAD on CA but with ischemic-LGE on CMR and 6 =ischemic cardiomyopathy with no LGE on CMR and severe CAD. The severity of epicardial involvement was defined by Gensini score. 231 patients were included in the final cohort, 77% were male and the mean age was 60.1±14 years. Bystander infarction represented 13% of the population, with only 3 % of bystander CAD. There is a low correlation between Gensini score and fibrosis for all the population (rpearson = 0, 22 p= 0,001), without correlation between LVEF and fibrosis. Bystander infarction had a lower ischemic necrosis (p<0,01), a higher proportion of atrial fibrillation compared to group 2 (p<0,02) and a higher proportion of extensive trabecular on LV compared to the others (p<0,01). Conclusion: Dilated cardiomyopathy with bystander CAD is a rare pathology, while one with bystander infarct is more frequent, with characteristics suggesting that it should be regarded as true dilated cardiomyopathy with embolism mechanism for infarction. These statements, which need to be confirmed, could have therapeutic implications, including screening for atrial fibrillation in dilated cardiomyopathy.
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Submitted on : Tuesday, April 7, 2020 - 4:01:35 PM
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Léa Margerit. Infarctus et coronaropathie concomitante dans un contexte de cardiopathie dilatée : prévalence et caractérisation. Médecine humaine et pathologie. 2019. ⟨dumas-02535453⟩

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