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Prise en charge et facteurs pronostiques des épisodes d'insuffisance circulatoire aiguë chez des patients atteints d'Hypertension Artérielle pulmonaire

Abstract : Pulmonary arterial hypertension ( PAH) is a disease characterized by an obstruction of the small pulmonary arteries leading ultimately to right heart failure. The evolution of this disease is sometimes punctuated by episodes of deterioration of the functional status of patients requiring admission to intensive care unit for monitoring and administration of inotropic drugs and / or vasopressors. Few evidence to date are available to guide physicians in the care of these patients and the pathophysiology of these episodes is still elusive.In a first part, we found a mortality of 41% in the intensive care unit (ICU) and tested some simple clinical and biological prognostic factors from the daily practice in a prospective cohort of patients with a standardized management. We have identified systemic blood pressure, serum sodium, serum creatinine, serum C -reactive Protein as prognostic factors. We found an influence of these events on the medium-term evolution of the patients.In a second step we tested the prognostic value of time derived indices of left ventricular function, variables suggested by magnetic resonance imaging studies. In this purpose, we used aplanation tonometry, an original and non-invasive tool. We found that the value of the left ventricular ejection time was associated with in ICU prognosis.In the third part we measured the impact and prognostic value of renal replacement therapy in case of threatening kidney failure in these patients. In a retrospective study, we observed 68 sessions of renal replacement therapy, continuous hemofiltration and intermittent hemodialysis. These sessions were complicated by hypotension in 50 % of cases. The high in ICU mortality and three months mortilty, respectively 47% and 73%, raises the question of the role of extracorporeal life support and urgent transplantation in these patients.These data underscore the severity of acute worsening in patients with PAH. More data are needed to improve the management of these patients and determine the best timing of exceptional treatment such as circulatory support and pulmonary or cardiopulmonary transplantation.
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Submitted on : Tuesday, December 17, 2013 - 6:42:09 PM
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  • HAL Id : tel-00920148, version 1



Benjamin Sztrymf. Prise en charge et facteurs pronostiques des épisodes d'insuffisance circulatoire aiguë chez des patients atteints d'Hypertension Artérielle pulmonaire. Médecine humaine et pathologie. Université Paris Sud - Paris XI, 2013. Français. ⟨NNT : 2013PA114839⟩. ⟨tel-00920148⟩



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