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Contribution à l'étude de la désadaptation cardiovasculaire à l'effort : évaluation des pressions de remplissages à un faible niveau de charge et réponse cardio-circulatoire lors d'un exercice dynamique maximal

Abstract : Despite normal investigations at rest, latent heart failure can be observed in a number of patients during exercise. We investigated the hypothesis of an impairment of cardiovascular reserve in two pathophysiological models: - in patients at high risk of heart failure with preserved ejection fraction, we measured left ventricular filling pressures at low exercise level in order to unmask early stages of left ventricular diastolic dysfunction;- moreover, using combined echocardiography and cardiopulmonary exercise testing, a comprehensive study of cardiovascular response to maximal exercise was performed in patients with sickle cell anemia which was chosen as a model of chronic high-output states. We showed that very low exercise level could unmask early stage heart failure with preserved ejection fraction. These results, initially observed using Doppler echocardiography, were confirmed by direct invasive measurement of left ventricular filling pressure during exercise. In patients with sickle cell anemia, we found a decrease of cardiac output response to exercise. This alteration of cardiovascular reserve was characterized by a chronotropic incompetence and a blunted left ventricular preload reserve. The pathophysiological data provided by our studies may help improve and optimize management of patients with heart failure. The stress protocols which have been developed and used in our investigations could be useful to study other models of heart diseases.
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Nadjib Hammoudi. Contribution à l'étude de la désadaptation cardiovasculaire à l'effort : évaluation des pressions de remplissages à un faible niveau de charge et réponse cardio-circulatoire lors d'un exercice dynamique maximal. Physiologie [q-bio.TO]. Université Pierre et Marie Curie - Paris VI, 2016. Français. ⟨NNT : 2016PA066598⟩. ⟨tel-01663497⟩

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