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, L'échocardiographie (ETT), qui permet de manière simultanée l'estimation des pressions et des volumes en 3D, pourrait être une autre méthode pour évaluer le CVAD. METHODE: 90 patients suspects d'hypertension pulmonaire (HTP) ont subi un CCD, une ETT incluant des acquisitions 3D du ventricule droit (VD) et une IRM dans un, Une méthode alternative et plus facile a été tirée de la combinaison de données de pressions en cathétérisme cardiaque droit (CCD) et de données de volumes issus de l'IRM cardiaque

, L'elastance artérielle pulmonaire (Ea), l'elastance systolique maximale ventriculaire (Emax) et le CVAD selon la formule Ea/Emax étaient calculés. Le CCD permettait de mesurer la PAPm et les RVP (résistances vasculaires pulmonaires) étaient calculées selon la formule (mPAP-PAPO/Q) où PAPO correspond à la pression artérielle pulmonaire occluse et Q au débit cardiaque. La PAPm était également estimée en ETT grâce à la Formule de Chemla (PAPm = 0,61 x PAPs + 2 mmHg). Les volumes VD et la fraction d'éjection (FEVD) (%) étaient obtenus d'une part en l'IRM et d'autre part en analyse volumétrique par ETT 3D (logiciel TomTec). Les valeurs d'Ea, Emax et CVAD étaient comparées entre les patients porteurs d'une PAPm < (n=41) ou ?25 mm Hg (n=79), Une ETT complète était également réalisée chez 30 patients normaux

, IRM-CCD 0,38 ± 0,19, r=0,798, p<0,001) and le CVAD (ETT 2,01 ± 1,28, IRM-CCD 2,32 ± 1,77, r=0,826, p<0,001) et la concordance était bonne en dépits d'une surestimation systématique des paramètres en 3DE comparativement aux valeurs IRM-CCD. L'Ea et le CVAD en ETT 3D étaient significativement plus faibles chez les patients qui avaient une PAPm < 25 mmHg que chez les autres patients alors que l'Emax n'était pas significativement différente. L'Ea et le CVAD en ETT 3D augmentaient de manière significative avec la sévérité de la, RESULTATS: Une bonne corrélation était observée entre l'ETT 3D et les mesures IRM-CCD pour l'Ea (ETT 1,27 ± 0, vol.94

, IRM-CCD) et les valeurs étaient significativement différentes entre les patients ayant une PAPm normale ou non, suggérant que lors de la défaillance du VD, il pouvait initialement augmenter sa contractilité et ainsi maintenir un CVAD efficace à des hauts niveaux de post-charge. L'évaluation échocardiographique de l'Ea, l'Emax et le CVAD pourrait donner des informations plus poussées dans l'évaluation de la réponse ventriculaire droite à l'élévation chronique de sa post-charge, CONCLUSION: L'Ea, l'Emax et le CVAD dérivés de l'ETT 3D étaient très bien corrélés au résultats du gold-standard actuel, p.2017

M. Cles, Ventricule droit, Couplage ventriculaire droit, Fonction ventriculaire droite, Echocardiographie tridimensionnelle, IRM cardiaque, p.-