Etude du remodelage du ventricule droit dans l’hypertension pulmonaire : du phénotypage approfondi à l'étude de la protéomique

Abstract : Right heart failure is the major cause of morbi-mortality in patients with pulmonary hypertension (PH). Improving right heart adaptive phenotyping using non-invasive imaging is needed in order to better understand the transition from right ventricular (RV) adaptation to maladaptation in PH.The first chapter of this thesis has been dedicated to demonstrate the reliability of echocardiography to detect PH in patients with group 1 or 3 PH, providing methodology pearls and pitfalls.The second chapter has enabled to identify, among the multiple right heart non-invasive imaging metrics, RV end-systolic remodeling indices as the strongest prognostic biomarkers in patients with pulmonary arterial hypertension (PAH), combined with the NYHA class and NT-proBNP levels.The third chapter has explored the role of immune biomarkers in PH, providing a practical application of right heart deep phenotyping to determine the circulating immune proteomic profile associated with right heart failure in patients with PAH. This screening proteomics study has identified high plasmatic levels of hepatic growth factor, nerve growth factor and stem cell growth factor beta to be associated with right heart maladaptation in two cohorts with PAH. The role of these biomarkers within the right ventricle itself remains to be fully explored.
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Myriam Amsallem. Etude du remodelage du ventricule droit dans l’hypertension pulmonaire : du phénotypage approfondi à l'étude de la protéomique. Cardiologie et système cardiovasculaire. Université Paris-Saclay, 2019. Français. ⟨NNT : 2019SACLS003⟩. ⟨tel-02280123v2⟩

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