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Master Thesis

Le remodelage inverse ventriculaire gauche précoce et tardif dans la cardiomyopathie dilatée : prévalence, pronostic et facteur prédictif

Abstract : Background: left ventricular reverse remodelling (LVRR) is indicative of a favourable prognosis and early identification of patients with a high probability of responding to medical treatment is critical for the subsequent therapeutic strategy. Purpose: in a single-centre retrospective study, we aimed to assess the prevalence of LVRR in a cohort of dilated cardiomyopathies (DCM) managed in a specialised centre, to compare its early or late occurrence and to investigate the presence of predictive factors for good or poor therapeutic response. Methods: all patients managed at the Heart Failure Unit of the Bordeaux University Hospital between January 2011 and January 2020 with a recent diagnosis of dilated cardiomyopathy with LVEF ≤ 40 % were included. The primary endpoint was the occurrence of LVRR at 12 months, defined as an improvement in LVEF ≥ 10% associated with a reduction in LVEDD ≥ 10% or their respective normalisation. LVRR was also assessed at 6 months, allowing differentiation of its early or late occurence. Results: out of 187 DCM included, the average age was 50 ± 14 years, 64% were males. 61% were primary DCM and 39% secondary DCM. Initial severity was important with 65% of patients in NYHA class III-IV, 57% had LVEF ≤ 25% and 62% had associated right ventricular dysfunction. At 3 months, 84% of patients were on optimal dose of RAAS blockers, 73% on beta-blockers and 88% on MRAs. At 12 months, 73% of patients had met the primary endpoint. The cardiovascular event-free survival of these patients was significantly better (p<0.0001). In multivariate analysis, 3 factors were negatively associated with the occurrence of left ventricular reverse remodelling, familial aetiology (OR 0.09 [0.03-0.28], p<0.001), presence of LBBB (OR 0.31 [0.11-0.85], p=0.023) and high systolic pulmonary artery pressure (OR 0.95 [0.92-0.99], p=0.012) ; 1 factor was positively associated with reverse remodelling, higher haemoglobin level (OR 1.32 [1.02-1.70], p=0.032). The presence of LBBB was significantly higher in the late reverse remodelling group (40 vs. 16%, p=0.003). The initial severity of our patients did not compromise the occurrence of LVRR. Conclusion: more than two thirds of the patients demonstrated LVRR, with a good prognosis as result. It appears important to allow time and focus on therapeutic optimisation before initiating invasive measures, apart from familial cardiomyopathy being the factor most strongly negatively associated with reverse remodelling in our study.
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Submitted on : Friday, November 12, 2021 - 9:52:50 AM
Last modification on : Friday, December 17, 2021 - 3:47:08 AM
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Tatiana Hertzog. Le remodelage inverse ventriculaire gauche précoce et tardif dans la cardiomyopathie dilatée : prévalence, pronostic et facteur prédictif. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03426194⟩



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