Notre population étant réduite et hétérogène pour les groupes d’HTP, certains paramètres se sont révélés être pronostiques en analyse univariée et non en analyse multivariée.
Nous n’avons pas étudié les traitements pris par les patients au cours du suivi ce qui n’a pas permis d’ajustement sur ce paramètre.
Nous n’avions pas de logiciel dédié à l’analyse de l’OD et avons utilisé, pour obtenir les valeurs de strain de l’OD, des outils classiquement utilisés pour l’étude du strain de l’OG. Il n’y avait donc pas de mesures automatisées et nous avons tracé manuellement les points d’intérêt sur des coupes 4 cavités qui ne permettent pas de prendre en compte l’OD en trois dimensions.
L’étude du strain requiert une bonne échogénicité, nous n’avons pas pu inclure certains patients présentant une HTP précapillaire.
Il n’existe pas actuellement de méthode standardisée pour l’analyse du strain atrial droit, cependant dans notre étude, les coefficients de corrélation intra-classe étaient supérieurs à 0.70 ce qui traduit une reproductibilité acceptable de la méthode.
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Dans notre population, 81 patients porteurs d’HTP précapillaire et à l’échogénicité suffisante, suivis en moyenne pendant 19 mois, le décès ou la transplantation pulmonaire n’ont pas pu être évités dans 31% des cas.
Dans cette cohorte, le strain longitudinal de l’OD, décomposé dans les phases réservoir, conduit et contractile, est apparu comme un facteur prédictif d’événement en analyse univariée (respectivement p=0.0006, p=0.02 et p=0.001). Cependant, en analyse multivariée, après ajustement sur l’âge, la classe de dyspnée NYHA et le BNP, c’est l’altération des fonctions réservoir (p=0.05) et de contraction (p=0.01) de l’OD qui est un facteur de risque de pronostic défavorable (décès ou transplantation), indépendamment de la dilatation de l’OD.
En ce qui concerne l’analyse du critère secondaire (décès, transplantation ou hospitalisation pour insuffisance cardiaque droite), la dilatation atriale neutralise l’effet pronostic du strain atrial, reliant donc ces 2 paramètres.
A notre connaissance, notre étude est la première à analyser le strain atrial dans l’HTP précapillaire quelle qu’en soit l’étiologie. Malgré ses limites, elle montre la pertinence de l’étude du strain de l’OD pour potentiellement anticiper l’évolution des patients atteints d’HTP pré-capillaire.
Le strain de l’OD est apparu comme un marqueur pronostique indépendant dans l’HTP précapillaire. Il semble prometteur pour identifier précocement les patients ayant une dysfonction atriale droite ce qui pourrait permettre d’ajuster certaines décisions thérapeutiques.
Nous espérons que ce travail pourra être poursuivi et complété, l’analyse des liens entre forme et fonction atriale pouvant être affinée.
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