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Microangiopathies Thrombotiques et Atteintes Cardiaques

Microangiopathies Thrombotiques et Atteintes Cardiaques. Stéphane Ederhy Hôpital Saint-Antoine, Paris. TTP is an acute rare disoder Incidence 4-6 case per million of the population

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Microangiopathies Thrombotiques et Atteintes Cardiaques

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  1. Microangiopathies Thrombotiques et Atteintes Cardiaques Stéphane Ederhy Hôpital Saint-Antoine, Paris

  2. TTP is an acute rare disoder • Incidence 4-6 case per million of the population • Thrombocytopenia, Hemolytic anemia, microvascular thrombosis and wide spread multiorgan microvascular thrombosis • With varying clinical sequelae

  3. 1- What is the frequency of clinical abnormalities in pts with TTP using sensitive methods to detect myocardial ischemia and cardiac dysfunction • 2- Is cardiac involvement an important cause of the continuing mortality of patients with TTP • 3- Does abnormal cardiac function persist in pts recovery from an acute episode of TTP • 4- Can identification of cardiac involvement and appropriate treatment reduce mortality in pts with TTP

  4. 292 articles : 30 articles with cardiac datas = 111 pts • Cardiac symptoms : 13 articles : 24 pts • Cardiac testing : 23 articles : 86 pts • Cardiac events : 21 articles : 47 pts • Follow up : 5 articles : 6 pts • Autopsy data : 24 articles : 51 pts Hawkins et al . Transfusion 2008 ; 48 : 385

  5. Cohort studies describing cardiac abnormalities in pts with TTP Hawkins et al . Transfusion 2008 ; 48 : 385

  6. Clinical cardiac involvement in TTP : a systematic reviewNumbers of articles and pts with TTT with reports of cardiax symp, testing, events and FU Hawkins Transfusion .2008 ;48 :382-392

  7. Myocardial Infarction

  8. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 1341 pts, retrospective Hugues C. J Thromb Haemost 2009;7:529-36

  9. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 1341 pts, retrospective Hugues C. J Thromb Haemost 2009;7:529-36

  10. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS Symptoms Hugues C. J Thromb Haemost 2009;7:529-36

  11. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 1341 pts, retrospective Hugues C. J Thromb Haemost 2009;7:529-36

  12. Cardiac Involvement and acute thrombocytopenic purpuratroponin T level Hugues C. J Thromb Haemost 2009;7:529-36

  13. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 13ECG Hugues C. J Thromb Haemost 2009;7:529-36

  14. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 13ECG modifications among pts with Troponin elevation Hugues C. J Thromb Haemost 2009;7:529-36

  15. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 13Echocardiography : 30 / 41 pts, 9 days Hugues C. J Thromb Haemost 2009;7:529-36

  16. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 13Troponin T level > 0.1 ug/l and mortality Hugues C. J Thromb Haemost 2009;7:529-36

  17. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 13Tp < 0.01 Hugues C. J Thromb Haemost 2009;7:529-36

  18. Cardiac Involvement and acute thrombocytopenic purpuraAssociation with Troponin T and IgG antibodies to ADAMTS 13ECG • 63 % of pts had a raised Tp T > 0.01 • 50 % of theses pts had symptoms • 60 % of theses pts had subtle abnormalities on the ECG • All echo were normal • Mortality and acute morbidity was associated with higher admission troponin T and raised IgG antibody to ADAMTS 13 (>67%) Hugues C. J Thromb Haemost 2009;7:529-36

  19. Myocardial Infarction in TTP : A review of the littératureDifference in MI rates between idiopathic and non-idiopathic TTP pts Wahla. European Journal Of Haematology 2008 81 311-316

  20. Myocardial Infarction in TTP : A single center experienceBaseline Characteristics Wahla. European Journal Of Haematology 2008 81 311-316

  21. Myocardial Infarction in TTP : A single center experienceTTP diagnostic variables between MI pts and non MI pts Wahla. European Journal Of Haematology 2008 81 311-316

  22. Myocardial Infarction in TTP : A single center experienceCardiac markers in MI pts Wahla. European Journal Of Haematology 2008 81 311-316

  23. Cardiovascular manifestations in pts with TTP : A single center experienceQ wave in ECG : Incidence of AMI in 21 % pts Gandhi. Clin Cardiol 2010 33 213-216

  24. Cardiovascular manifestations in pts with TTP : A single center experienceBaseline Gandhi. Clin Cardiol 2010 33 213-216

  25. Acute Myocardial infarction in TMAMultivariate analysis of factors associated with AMI in the course of TMA Patschan Nephrol Dial Transplant .2006 ;21 :1579-1554

  26. Rythme Trouble

  27. Cardiovascular manifestations in pts with TTP : A single center experienceIncidence of trouble rythm Gandhi. Clin Cardiol 2010 33 213-216

  28. Cardiovascular manifestations in pts with TTP : A single center experienceIncidence of trouble rythm and mortality Gandhi. Clin Cardiol 2010 33 213-216

  29. Congestive Heart Failure

  30. Incidence and Prognosis of acute heart failure in the thrombotic microangiopathies • Between 1976 and 2002, 220 adults pts (average 48 y, 69 % w) with TMA • 45 % Idiopathic • 21 (9.5%) had acute HF • HF symptoms were recognized on average 8 days after the diagnosis of TMA Gami A. Am J of Medicine 2005 118 544-547

  31. Incidence of Heart Failure Gami. American Journal Of Medicine 2005 118 544-547

  32. Gami. American Journal Of Medicine 2005 118 544-547

  33. Mortality P=0.04 Gami. American Journal Of Medicine 2005 118 544-547

  34. Sane European Journal Of Haematology .2008 ;82 :83-92

  35. Cardiovascular manifestations in pts with TTP : A single center experience Gandhi. Clin Cardiol 2010 33 213-216

  36. Studies of myocardial damage in TTP

  37. Clinical cardiac involvement in TTP : a systematic reviewCardiac symptoms and events in pts with TTP111 pts Hawkins Transfusion .2008 ;48 :382-392

  38. Echocardiography13 pts - 9 articles Hawkins et al . Transfusion 2008 ; 48 : 385

  39. Autopsy Data48 pts Hawkins et al . Transfusion 2008 ; 48 : 385

  40. Conclusions • Few prospectives studies have investigated cardiac involvement in TTP • Limited datas suggest that cardiac involvement may be an important cause of mortality • Better screnning for cardiac involvement , systematic evaluation for cardiac symptoms and sensitive cardiac testing will identify a high frequency of CA in pts with TTP

  41. Study Limitation • Retrospective • Suivi • Prise en charge Hawkins Transfusion .2008 ;48 :382-392

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