L’ÉTUDE DE LA FONCTION ENDOTHÉLIALE PERMET DE PRÉDIRE L’EXISTENCE ET LA SÉVÉRITÉ DE LA MALADIE CORONAIRE.

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Publiée déc. 9, 2009
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Vol. 87 No 12 (2009): Revue déc. 2009

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Salem Abdessalem
Sajed Majadlah
Nizar Bouslimi
Sami Mourali
Rachid Mechemeche

Résumé

Prérequis : La dysfonction de l’endothélium est de plus en plus incriminée dans le processus athéromateux. Sa place dans la pratique clinique est cependant encore mal définie
Objectif : Etudier prospectivement la valeur diagnostique de la fonction endothéliale par rapport à la coronarographie et analyser la relation entre la sévérité de la dysfonction endothéliale et la diffusion de la maladie coronaire.
Méthode : Ont été inclus par tirage au sort 50 patients (37 hommes et 13 femmes) candidats à une coronarographie d’âge moyen égal à 59.9+12.6 ans. L’étude de la fonction endothéliale a été effectuée avant la coronarographie par la mesure échographique de l’accroissement relatif du diamètre de l’artère humérale  (FMD%) après une ischémie provoquée de l’avant bras. Le traitement de l’insuffisance coronaire n’a pas été arrêté avant le test.
Résultat : Une dysfonction endothéliale a été objectivée chez 36 patients et une coronaropathie significative chez 38. La dysfonction endothéliale a été corrélée à la coronaropathie avec une sensibilité de 89.5%, une spécificité de 83%, une valeur prédictive positive (VPP) de 94.4% et une valeur prédictive négative de 71.4%. La corrélation linéaire entre la FMD% et le statut coronaire a été hautement significative (rs=-0.44 ; p=0.001). Un FMD% de 8% a permis une excellente séparation des patients à coronaires normales et multitronculaires. Dans l’analyse multivariée la dysfonction endothéliale a été le seul facteur prédictif indépendant de
coronaropathie (p=0.02).
Conclusion : La dysfonction endothéliale a été fortement corrélée à la coronaropathie (VPP=94.4%) avec une relation directe entre la sévérité de la dysfonction endothéliale et l’étendu de l’atteinte coronaire. La place de ce test mérite d’être précisée en pratique clinique car non invasif, fiable et peu coûteux.

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