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Au moment d'être admis(e) à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité ,
, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux, individuels et sociaux
, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte
, Je ne tromperai jamais leur confiance et n'exploiterai pas le pouvoir hérité des circonstances pour forcer les consciences
, Je ne me laisserai pas influencer par la soif du gain ou la recherche de la gloire
, Admis(e) dans l'intimité des personnes, je tairai les secrets qui me seront confiés
, Reçu(e) à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs. Je ferai tout pour soulager les souffrances. Je ne prolongerai pas abusivement les agonies
, Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés
, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité
, Résumé Contexte : L'atteinte cardiaque est aujourd'hui reconnue dans le cadre de la définition de l'HTA maligne. Elle peut se manifester par u ne élévation de troponine, une dysfonction systolique ou encore une hypertrophie ventriculaire gauche disproportionnée, Sa patho génèse reste néanmoins incertaine. L'IRM cardiaque semble un outil idéal pour progresser dans la compréhension de sa physiopathologie
, Les IRM étaient considérées en phase aiguë si le délai de réalisation post diagnostic était inférieur ou égal à 40 jours. Nous avons recueilli les volumes télédiastolique, télésystolique, la FEVG, la masse ventriculaire gauche, la cinétique segmentaire à partir de séquences SSFP, et la présence ou non de rehaussement tardif pathologique 10 minutes après injection de chélate de gadoli nium par une séquence PSIR (± HR), Méthode : Nous avons inclus rétrospectivement les patients de la cohorte bordelaise d'HTA maligne ayant bénéficié d'une IRM cardiaque entre janvier 2009 et janvier 2020
, Le délai moyen de réalisation de l'IRM cardiaque était de 20,9 jours (±17,8). 33 patients ont bénéficié d'une IRM en phase aiguë, réalisée avec un délai moyen de 14, Résultats : Nous avons inclus 39 patients sur les 202 présents dans la cohorte bordelaise
, Seuls deux patients présentaient du rehaussement sous endocardique sans contexte évocateur de syndrome coronarien aigu. Une IRM de suivi a été réalisée chez 18 de ces patients retrouvant une diminution significative de la MVG indexée (92,8 ± 20,1gr/m² (p < 0,05)) et une majoration, Les données de l'IRM dans ce sous-groupe retrouvaient une MVG indexée moyenne de 127,1 gr/m² (± 41,8)
, Conclusion : Ces données suggèrent que l'HVG disproportionnée parfois observée à la phase aiguë d'HTA maligne semble secondaire à un mécanisme mixte. Ce dernier associerait une hyperplasie myocytaire et une atteinte fibrotique excessive, probablement sous l'effet de l'hyperactivation du SRAA. L'absence de séquelle ischémique sur les séquences de rehaussement tardif chez la majorité des patients suggère une cause microvasculaire diffuse expliquant l'ischémie myocardique
, Mots clés : hypertension artérielle maligne, imagerie par résonance magnétique cardiaque, hypertrophie ventriculaire gauche Abstract Context: Cardiac damage is now recognized as part of the definition of malignant hypertension. It can manifest itself as troponin elevation, systolic dysfunction or disproportionate left ventricular hypertrophy. However, its pathogenesis remains uncertain. Cardiac MRI seems to be an
, MRIs were considered acute if the post-diagnosis delay was less than or equal to 40 days. We collected telediastolic, telestolic, LVEF, left ventricular mass, segmental kinetics from SSFP sequences, and the presence or absence of pathological late enhancement 10 minutes after injection of gadolinium chelate by a PSIR sequence (± HR). The most recent cardiac MRIs included T2-weighted and T1 mapping sequences, 2009.
, The mean time to complete cardiac MRI was 20.9 days (±17.8). 33 patients received an acute MRI, performed with a mean time of 14.8 days (±10.3). MRI data in this subgroup showed a mean indexed LVM of 127.1 g/m² (±41.8). There were no significant anomalies on the T2-weighted sequences
, Late enhancement abnormalities were found in 34.4% of patients, mostly of mesomyocardial location. Only two patients had subendocardial elevation without a context suggestive of acute coronary syndrome. Follow-up MRI was performed in 18 of these patients with a significant decrease in indexed LVM (92.8 ± 20.1gr/m² (p < 0.05)) and a significant
, Conclusion: These data suggest that the disproportionate LVH sometimes observed in the acute phase of malignant hypertension appears to be secondary to a mixed mechanism. The latter would associate myocyte hyperplasia and excessive fibrotic damage
, Key words : malignant hypertension, cardiac magnetic resonance imaging