{"id":1781,"date":"2025-11-13T14:41:50","date_gmt":"2025-11-13T11:41:50","guid":{"rendered":"https:\/\/wiki.dev.voka.io\/diseases\/uncategorized\/cardiomyopathie-dilatee\/"},"modified":"2025-11-19T15:28:40","modified_gmt":"2025-11-19T12:28:40","slug":"cardiomyopathie-dilatee","status":"publish","type":"diseases_post","link":"https:\/\/wiki.dev.voka.io\/fr\/maladies\/cardiologie\/cardiomyopathie-dilatee\/","title":{"rendered":"Cardiomyopathie dilat\u00e9e&nbsp;: \u00e9tiologie, pathog\u00e9nie, sympt\u00f4mes, diagnostic, m\u00e9thodes de traitement"},"content":{"rendered":"<p><?xml encoding=\"UTF-8\" ?><\/p>\n<p>La cardiomyopathie dilat\u00e9e (CMD) est une maladie du myocarde caract\u00e9ris\u00e9e par une dilatation (\u00e9largissement) et un dysfonctionnement systolique du ventricule gauche ou des deux ventricules en l\u2019absence de maladie coronarienne, de malformations cong\u00e9nitales, d\u2019hypertension et d\u2019anomalies valvulaires qui pourraient expliquer ces changements. Selon des \u00e9tudes bas\u00e9es sur la population, la pr\u00e9valence de la CMD est d\u2019environ 0,036-0,400\u00a0%.<\/p>\n<figure class=\"wp-block-video\" id=\"animation-3d-cardiomyopathie-dilatee\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/acquired-heart-diseases\/dilated-cardiomyopathy\/dilated-cardiomyopathy.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Animation 3D : cardiomyopathie dilat\u00e9e<\/figcaption><\/figure>\n<h2 class=\"wp-block-heading\" id=\"etiologie\">\u00c9tiologie<\/h2>\n<p>L\u2019\u00e9tiologie de la cardiomyopathie dilat\u00e9e (CMD) est tr\u00e8s h\u00e9t\u00e9rog\u00e8ne et comprend des causes h\u00e9r\u00e9ditaires (g\u00e9n\u00e9tiques\/familiales) et acquises\u00a0:<\/p>\n<h3 class=\"wp-block-heading\" id=\"causes-genetiques\">Causes g\u00e9n\u00e9tiques<\/h3>\n<ul class=\"wp-block-list\">\n<li>Elle est transmise de fa\u00e7on pr\u00e9dominante sur un mode autosomique.<\/li>\n<li>Jusqu\u2019\u00e0 50\u00a0% des cas peuvent \u00eatre de nature familiale.<\/li>\n<li>Les principaux g\u00e8nes sont TTN, LMNA, FLNC, BAG3, DSP, RBM20, MYH7, SCN5A.<\/li>\n<li>Elle peut \u00eatre associ\u00e9e \u00e0 des arythmies, \u00e0 des anomalies de conduction ou \u00e0 un syndrome de chevauchement (par exemple, avec des preuves de CM arythmog\u00e8ne).<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"causes-inflammatoires-post-myocardite\">Causes inflammatoires (post-myocardite)<\/h3>\n<ul class=\"wp-block-list\">\n<li>Souvent secondaire \u00e0 une infection virale (parvovirus B19, HHV-6, ad\u00e9novirus, ent\u00e9rovirus).<\/li>\n<li>Elle peut \u00eatre auto-immune, associ\u00e9e \u00e0 des maladies telles que le lupus \u00e9ryth\u00e9mateux diss\u00e9min\u00e9, la sarco\u00efdose, la polyarthrite rhumato\u00efde, etc.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"expositions-toxiques\">Expositions toxiques<\/h3>\n<ul class=\"wp-block-list\">\n<li>L\u2019alcool a une toxicit\u00e9 directe sur le myocarde, en particulier \u00e0 des doses \u00e9lev\u00e9es et en cas de consommation prolong\u00e9e.<\/li>\n<li>Chimioth\u00e9rapie\u00a0: anthracyclines (doxorubicine), trastuzumab, inhibiteurs de points de contr\u00f4le immunitaire.<\/li>\n<li>La coca\u00efne et les amph\u00e9tamines provoquent des vasospasmes et des l\u00e9sions directes du myocarde.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"troubles-du-metabolisme\">Troubles du m\u00e9tabolisme<\/h3>\n<ul class=\"wp-block-list\">\n<li>Carence en thiamine, carnitine, s\u00e9l\u00e9nium, zinc et cuivre.<\/li>\n<li>Hypothyro\u00efdie, hyperthyro\u00efdie, diab\u00e8te sucr\u00e9, ph\u00e9ochromocytome.<\/li>\n<li>Maladies d\u2019accumulation\u00a0: h\u00e9mochromatose, maladie de Fabry, amylo\u00efdose.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"tachyarythmie\">Tachyarythmie<\/h3>\n<ul class=\"wp-block-list\">\n<li>Fibrillation auriculaire prolong\u00e9e non trait\u00e9e, tachycardie auriculaire ou ventriculaire, tachycardie paroxystique.<\/li>\n<li>Peut \u00eatre r\u00e9versible avec un contr\u00f4le de la FC\/du rythme cardiaque.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"cardiomyopathie-du-peripartum\">Cardiomyopathie du p\u00e9ripartum<\/h3>\n<p>Survient au cours des derniers mois de la grossesse ou dans les 5\u00a0mois apr\u00e8s l\u2019accouchement.<\/p>\n<h3 class=\"wp-block-heading\" id=\"cas-idiopathiques\">Cas idiopathiques<\/h3>\n<p>Un diagnostic d\u2019exclusion lorsqu\u2019aucune cause secondaire n\u2019est identifi\u00e9e et que les tests g\u00e9n\u00e9tiques ne donnent pas d\u2019informations.<\/p>\n<h2 class=\"wp-block-heading\" id=\"pathogenese-de-la-cardiomyopathie-dilatee\">Pathogen\u00e8se de la cardiomyopathie dilat\u00e9e<\/h2>\n<p>Quelle qu\u2019en soit la cause, les m\u00e9canismes pathog\u00e9niques sont similaires\u00a0: l\u00e9sions des cardiomyocytes, activation d\u2019une inflammation, remodelage du myocarde et d\u00e9t\u00e9rioration progressive de la fonction contractile.<\/p>\n<p><strong>Stades de la cardiomyopathie dilat\u00e9e<\/strong>\u00a0:<\/p>\n<ol class=\"wp-block-list\">\n<li>L\u00e9sions primaires des cardiomyocytes conduisant \u00e0 l\u2019activation d\u2019une inflammation\u00a0:\n<ul class=\"wp-block-list\">\n<li>G\u00e9n\u00e9tique\u00a0: perturbations de la structure du sarcom\u00e8re, du noyau, du cytosquelette, etc.\u00a0;<\/li>\n<li>Toxique\u00a0: accumulation de radicaux libres, dysfonctionnement mitochondrial, dommages directs aux membranes des cardiomyocytes\u00a0;<\/li>\n<li>Virale\u00a0: inflammation chronique et fibrose r\u00e9sultant d\u2019une myocardite auto-immune.<\/li>\n<\/ul>\n<\/li>\n<li>Perturbation du m\u00e9tabolisme du calcium intracellulaire, du m\u00e9tabolisme \u00e9nerg\u00e9tique et de l\u2019apoptose des cardiomyocytes.<\/li>\n<li>Remodelage du myocarde\u00a0: amincissement de la paroi, dilatation de la cavit\u00e9 (principalement du ventricule gauche, plus rarement des deux ventricules), d\u00e9veloppement d\u2019une fibrose interstitielle. La dilatation annulaire et le dysfonctionnement du muscle papillaire entra\u00eenent souvent une insuffisance de la valve atrio-ventriculaire.<\/li>\n<li>Dysfonctionnement systolique progressif \u2192 diminution de la fraction d\u2019\u00e9jection.<\/li>\n<li>L\u2019activation compensatoire des syst\u00e8mes neurohormonaux (SRAA, sympatho-adr\u00e9naline), qui am\u00e9liore l\u2019h\u00e9modynamique \u00e0 court terme, peut conduire \u00e0 terme \u00e0 une insuffisance cardiaque congestive.<\/li>\n<\/ol>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/acquired-heart-diseases\/dilated-cardiomyopathy\/new-thinned-left-ventricular-wall-and-cavity-dilation.webp\" alt=\"Paroi ventriculaire gauche fine et dilatation de la cavit\u00e9\"><figcaption class=\"wp-element-caption\">Paroi ventriculaire gauche fine et dilatation de la cavit\u00e9\u00a0: <a href=\"https:\/\/catalog.voka.io\/en\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/7b0d0575-5bd2-4294-a1a7-c720c52b9654\/075ceff0-6f2e-42b4-a838-5397f2edea6b\/017bd1ac-84be-44ce-9057-2af362a5b0af\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">mod\u00e8le 3D<\/a><\/figcaption><\/figure>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/acquired-heart-diseases\/dilated-cardiomyopathy\/mitral-regurgitation-due-to-lv-cavity-and-annulus-dilatation.webp\" alt=\"Insuffisance mitrale due \u00e0 la dilatation de la cavit\u00e9 ventriculaire gauche et de l'anneau valvulaire\"><figcaption class=\"wp-element-caption\">Insuffisance mitrale due \u00e0 la dilatation de la cavit\u00e9 ventriculaire gauche et de l\u2019anneau valvulaire\u00a0: <a href=\"https:\/\/catalog.voka.io\/en\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/7b0d0575-5bd2-4294-a1a7-c720c52b9654\/075ceff0-6f2e-42b4-a838-5397f2edea6b\/017bd1ac-84be-44ce-9057-2af362a5b0af\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">mod\u00e8le 3D<\/a><\/figcaption><\/figure>\n<h2 class=\"wp-block-heading\" id=\"manifestations-cliniques\">Manifestations cliniques<\/h2>\n<p><strong>Les sympt\u00f4mes de la cardiomyopathie dilat\u00e9e<\/strong> sont dus \u00e0 un dysfonctionnement systolique progressif et \u00e0 une stase dans la circulation syst\u00e9mique et pulmonaire\u00a0:<\/p>\n<ul class=\"wp-block-list\">\n<li>Dyspn\u00e9e \u00e0 l\u2019effort, se transformant \u00e9ventuellement en dyspn\u00e9e au repos\u00a0;<\/li>\n<li>Fatigue, diminution de la tol\u00e9rance \u00e0 l\u2019activit\u00e9 physique\u00a0;<\/li>\n<li>Orthopn\u00e9e et dyspn\u00e9e paroxystique nocturne\u00a0;<\/li>\n<li>Gonflement des extr\u00e9mit\u00e9s inf\u00e9rieures\u00a0;<\/li>\n<li>Hypertrophie du foie, ascite\u00a0;<\/li>\n<li>Syncope, vertiges (possibles en cas d\u2019arythmie ou d\u2019hypotension)\u00a0;<\/li>\n<li>Tachycardie, troubles du rythme cardiaque (en particulier fibrillation auriculaire et arythmie ventriculaire)\u00a0;<\/li>\n<li>Plus rarement, douleur thoracique due \u00e0 une isch\u00e9mie sous-endocardique.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\" id=\"diagnostic-de-la-cardiomyopathie-dilatee\">Diagnostic de la cardiomyopathie dilat\u00e9e<\/h2>\n<p>Le diagnostic de la CMD repose sur la constatation d\u2019une dilatation du ventricule gauche et d\u2019un dysfonctionnement systolique non expliqu\u00e9s par l\u2019isch\u00e9mie, l\u2019hypertension, des malformations valvulaires ou une pathologie cong\u00e9nitale. L\u2019objectif du diagnostic est de confirmer le ph\u00e9notype cardiomyopathique, de d\u00e9terminer les causes et d\u2019\u00e9valuer la gravit\u00e9 des modifications des structures cardiaques, ainsi que la probabilit\u00e9 de d\u00e9velopper des effets ind\u00e9sirables.<\/p>\n<h3 class=\"wp-block-heading\" id=\"methodes-instrumentales\">M\u00e9thodes instrumentales<\/h3>\n<ol class=\"wp-block-list\">\n<li><strong>L\u2019\u00e9chographie cardiaque<\/strong> est la principale m\u00e9thode de diagnostic primaire\u00a0:<\/li>\n<\/ol>\n<ul class=\"wp-block-list\">\n<li>Le LVEDV est augment\u00e9 (>\u00a0150-180\u00a0ml ou index\u00e9 >\u00a075\u00a0ml\/m\u00b2)\u00a0;<\/li>\n<li>Fraction d\u2019\u00e9jection r\u00e9duite (<\u00a045\u00a0%) ;<\/li>\n<li>Hypokin\u00e9sie globale sans anomalies r\u00e9gionales\u00a0;<\/li>\n<li>Souvent\u00a0: r\u00e9gurgitation mitrale et tricuspidienne, hypertension pulmonaire, dilatation du ventricule droit.<\/li>\n<\/ul>\n<ol start=\"2\" class=\"wp-block-list\">\n<li><strong><span class=\"glossary-term\" data-title=\"IRM (imagerie par r\u00e9sonance magn\u00e9tique)\" data-tooltip=\"L&#039;imagerie par r\u00e9sonance magn\u00e9tique (IRM) est une technique moderne et non invasive de radiodiagnostic qui permet d&#039;obtenir des images en coupe des organes et des tissus internes. Cet examen repose sur le ph\u00e9nom\u00e8ne de r\u00e9sonance magn\u00e9tique nucl\u00e9aire. Le principal avantage de l&#039;IRM est l&#039;absence de rayonnements ionisants (radiation).\" data-link=\"https:\/\/wiki.dev.voka.io\/fr\/glossaire\/irm\/\">IRM<\/span> cardiaque avec gadolinium<\/strong> (contraste tardif au gadolinium)\u00a0:<\/li>\n<\/ol>\n<ul class=\"wp-block-list\">\n<li>Clarifie la structure du myocarde et les caract\u00e9ristiques des tissus\u00a0: fibrose, \u0153d\u00e8me, infiltration graisseuse\u00a0;<\/li>\n<li>Sch\u00e9ma typique de la CMD\u00a0: accumulation m\u00e9so- ou sous-\u00e9picardique de gadolinium dans la paroi lat\u00e9rale ou septale\u00a0;<\/li>\n<li>Indispensable en cas de suspicion de myocardite, de sarco\u00efdose et de maladies d\u2019accumulation.<\/li>\n<\/ul>\n<ol start=\"3\" class=\"wp-block-list\">\n<li><strong>Coronarographie par tomodensitom\u00e9trie\/coronarographie invasive<\/strong>\u00a0:<\/li>\n<\/ol>\n<ul class=\"wp-block-list\">\n<li>Elle est effectu\u00e9e pour exclure une maladie coronarienne chez les patients \u00e2g\u00e9s de plus de 35\u00a0ans ou en pr\u00e9sence de facteurs de risque\u00a0;<\/li>\n<li>Obligatoire en cas de douleur thoracique classique, d\u2019anomalies r\u00e9gionales \u00e0 l\u2019\u00e9chographie cardiaque ou d\u2019accumulation tardive de gadolinium.<\/li>\n<\/ul>\n<ol start=\"4\" class=\"wp-block-list\">\n<li><strong>Moniteur Holter ou ECG ambulatoire<\/strong> (24-72\u00a0h)\u00a0:<\/li>\n<\/ol>\n<ul class=\"wp-block-list\">\n<li>Arythmies ventriculaires (VE, VT), FA, tachycardie, pause, bloc (surtout en cas de suspicion de forme mutante LMNA)\u00a0;<\/li>\n<li>Aide \u00e0 la s\u00e9lection des th\u00e9rapies et au choix d\u2019un DCI.<\/li>\n<\/ul>\n<ol start=\"5\" class=\"wp-block-list\">\n<li><strong><span class=\"glossary-term\" data-title=\"Biopsie\" data-tooltip=\"La biopsie (du grec bios \u2014 vie et opsis \u2014 regard\/vision) est une m\u00e9thode d\u2019investigation consistant \u00e0 pr\u00e9lever, de mani\u00e8re invasive, des cellules ou des tissus (biopsat) d\u2019un organisme vivant \u00e0 des fins diagnostiques. Le mat\u00e9riel obtenu est soumis \u00e0 une analyse microscopique, le plus souvent histologique.\" data-link=\"https:\/\/wiki.dev.voka.io\/fr\/glossaire\/biopsie\/\">Biopsie<\/span> myocardique<\/strong> (comme indiqu\u00e9)\u00a0:<\/li>\n<\/ol>\n<ul class=\"wp-block-list\">\n<li>En cas de suspicion\u00a0: myocardite active, maladies infiltrantes (amylo\u00efdose, sarco\u00efdose)\u00a0;<\/li>\n<li>Utilisation limit\u00e9e, n\u00e9cessite des lectures pr\u00e9cises et un haut niveau d\u2019ex\u00e9cution.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"methodes-en-laboratoire\">M\u00e9thodes en laboratoire<\/h3>\n<ol class=\"wp-block-list\">\n<li><strong>BNP\/NT-proBNP\u00a0:<\/strong><\/li>\n<\/ol>\n<p>Il s\u2019agit du biomarqueur le plus sensible de l\u2019insuffisance cardiaque congestive. Les niveaux augmentent proportionnellement au degr\u00e9 de surcharge de volume et de pression. Des valeurs \u00e9lev\u00e9es indiquent une d\u00e9compensation, des valeurs faibles permettent d\u2019exclure l\u2019HF.<\/p>\n<ol start=\"2\" class=\"wp-block-list\">\n<li><strong>Troponines sp\u00e9cifiques du c\u0153ur<\/strong> (I ou T)\u00a0:<\/li>\n<\/ol>\n<p>Une \u00e9l\u00e9vation mod\u00e9r\u00e9e est possible en cas d\u2019inflammation active (par exemple, myocardite) ou de distension myocardique marqu\u00e9e. Une \u00e9l\u00e9vation significative et aigu\u00eb n\u00e9cessite l\u2019exclusion de l\u2019infarctus du myocarde.<\/p>\n<ol start=\"3\" class=\"wp-block-list\">\n<li><strong>Hormones thyro\u00efdiennes<\/strong> (TTG, T3 et T4 libres)\u00a0:<\/li>\n<\/ol>\n<p>L\u2019hypothyro\u00efdie peut provoquer un dysfonctionnement systolique\u00a0; l\u2019hyperthyro\u00efdie peut provoquer une CMD induite par la tachycardie. <\/p>\n<ol start=\"4\" class=\"wp-block-list\">\n<li><strong>Glucose et h\u00e9moglobine glyqu\u00e9e<\/strong> (HbA1c)\u00a0:<\/li>\n<\/ol>\n<p>Le diab\u00e8te sucr\u00e9 est associ\u00e9 au d\u00e9veloppement de la cardiomyopathie diab\u00e9tique et exacerbe \u00e9galement l\u2019\u00e9volution de l\u2019HF. <\/p>\n<ol start=\"5\" class=\"wp-block-list\">\n<li><strong>Ferritine, fer s\u00e9rique, transferrine, saturation de la transferrine\u00a0:<\/strong><\/li>\n<\/ol>\n<p>Permettre la d\u00e9tection d\u2019une carence en fer ou d\u2019une h\u00e9mochromatose. Cette derni\u00e8re peut conduire \u00e0 une cardiomyopathie secondaire avec dysfonctionnement progressif du ventricule gauche.<\/p>\n<ol start=\"6\" class=\"wp-block-list\">\n<li><strong>Marqueurs d\u2019inflammation et d\u2019auto-immunit\u00e9 <\/strong>(anticorps antinucl\u00e9aires, facteur rhumato\u00efde, anticorps anti-cardiolipines, etc.)\u00a0:<\/li>\n<\/ol>\n<p>r\u00e9alis\u00e9e lorsqu\u2019une nature auto-immune ou inflammatoire syst\u00e9mique de la maladie est suspect\u00e9e\u00a0: lupus \u00e9ryth\u00e9mateux diss\u00e9min\u00e9, scl\u00e9rodermie, myocardite, etc. <\/p>\n<ol start=\"7\" class=\"wp-block-list\">\n<li><strong>Enzyme de conversion de l\u2019angiotensine, r\u00e9cepteur soluble de l\u2019interleukine-2 et calcium\u00a0:<\/strong><\/li>\n<\/ol>\n<p>En cas de suspicion de sarco\u00efdose cardiaque. Particuli\u00e8rement pertinent lorsqu\u2019il est associ\u00e9 \u00e0 des anomalies conductives ou \u00e0 des changements infiltratifs peu clairs \u00e0 l\u2019IRM.<\/p>\n<ol start=\"8\" class=\"wp-block-list\">\n<li><strong>Tests h\u00e9patiques, cr\u00e9atinine, \u00e9lectrolytes\u00a0:<\/strong><\/li>\n<\/ol>\n<p>Tests r\u00e9guliers pour d\u00e9terminer les manifestations syst\u00e9miques de l\u2019insuffisance cardiaque et pour \u00e9valuer la tol\u00e9rance au traitement.<\/p>\n<ol start=\"9\" class=\"wp-block-list\">\n<li><strong>Tests g\u00e9n\u00e9tiques\u00a0:<\/strong><\/li>\n<\/ol>\n<p>indiqu\u00e9s en cas d\u2019ant\u00e9c\u00e9dents familiaux de cardiomyopathie, de mort subite d\u2019origine cardiaque, de blocs, de dysfonctionnement grave \u00e0 un jeune \u00e2ge ou en l\u2019absence de causes secondaires. Des panels de g\u00e8nes associ\u00e9s \u00e0 la CMD (le plus souvent TTN, LMNA, BAG3, BAG3, FLNC, SCN5A, etc.) sont utilis\u00e9s.<\/p>\n<div class=\"social-banner-block\">\n<div class=\"social-banner-content\">\n<p class=\"h5-title text-black\">Retrouvez d\u2019autres contenus scientifiquement exacts sur nos m\u00e9dias sociaux<\/p>\n<p><span class=\"social-banner-text text-grey\">Abonnez-vous et ne manquez pas les derni\u00e8res ressources<\/span><\/p>\n<div class=\"social-links-wrapper\"><a class=\"social-icon-link\" href=\"https:\/\/www.facebook.com\/VOKA3DAnatomyAndPathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/facebook.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.instagram.com\/voka.io\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/insta.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.linkedin.com\/company\/voka-io\/posts\/?feedView=all\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/linkedin.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.youtube.com\/@vokaio\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/youtube.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.pinterest.com\/voka3danatomyandpathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/pinterest.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.tiktok.com\/@voka.io\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/tiktok.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/discord.gg\/7ejUpq8DRR\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/discord.svg\" alt=\"social link\"><\/a><\/div>\n<\/div>\n<p><img decoding=\"async\" class=\"social-banner-image\" loading=\"lazy\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/social-media-banner-mobile-image.webp\" alt=\"Banner background\"><\/div>\n<h2 class=\"wp-block-heading\" id=\"traitement-de-la-cardiomyopathie-dilatee\">Traitement de la cardiomyopathie dilat\u00e9e<\/h2>\n<h3 class=\"wp-block-heading\" id=\"therapie-medicale\">Th\u00e9rapie m\u00e9dicale<\/h3>\n<p>Le traitement m\u00e9dicamenteux<strong><\/strong>de la CMD n\u00e9cessite une approche globale et strictement individuelle, en tenant compte des caract\u00e9ristiques cliniques et fonctionnelles du patient.<\/p>\n<p><strong>Les principaux groupes de m\u00e9dicaments sont les suivants\u00a0:<\/strong><\/p>\n<ul class=\"wp-block-list\">\n<li>Inhibiteurs de l\u2019ECA\/ARB\/ARNI (sacubitril\/valsartan)\u00a0: am\u00e9lioration de la survie, r\u00e9duction des hospitalisations\u00a0;<\/li>\n<li>B\u00eata-bloquants (bisoprolol, carv\u00e9dilol, n\u00e9bivolol)\u00a0: r\u00e9duction de la mortalit\u00e9\u00a0;<\/li>\n<li>Antagonistes du r\u00e9cepteur min\u00e9ralocortico\u00efde\u00a0: lorsque FE <\u00a035\u00a0%\u00a0;<\/li>\n<li>Inhibiteurs du SGLT2 (dapa\/empagliflozine)\u00a0: am\u00e9lioration du pronostic ind\u00e9pendamment de la pr\u00e9sence d\u2019un diab\u00e8te\u00a0;<\/li>\n<li>Diur\u00e9tiques\u00a0: pour les sympt\u00f4mes de r\u00e9tention d\u2019eau\u00a0;<\/li>\n<li>Ivabradine\u00a0: lorsque la FC est >\u00a070 en rythme sinusal si les b\u00eata-bloquants sont inad\u00e9quats\u00a0;<\/li>\n<li>Anticoagulants\u00a0: en cas de FA, de pr\u00e9sence de caillots sanguins, de FC \u00e9lev\u00e9e.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"therapie-chirurgicale\">Th\u00e9rapie chirurgicale<\/h3>\n<ul class=\"wp-block-list\">\n<li><strong>Implantation d\u2019un appareil<\/strong>\u00a0:\n<ul class=\"wp-block-list\">\n<li>DAI (d\u00e9fibrillateur automatique implantable)\u00a0: si FE <\u00a035\u00a0%, NYHA II-III et risque de VT\u00a0;<\/li>\n<li>CRT-P\/CRT-D (th\u00e9rapie de resynchronisation)\u00a0: si QRS >130\u00a0ms, FE <35\u00a0%, rythme sinusal.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Correction chirurgicale de la r\u00e9gurgitation mitrale<\/strong> (secondaire) en cas de\u00a0:\n<ul class=\"wp-block-list\">\n<li>R\u00e9gurgitation mitrale fonctionnelle de niveau\u00a0II \u00e0 III\u00a0;<\/li>\n<li>FEVG 30-50\u00a0%, DCD LV <\u00a070\u00a0mm (pas de dilatation LV significative)\u00a0;<\/li>\n<li>Pr\u00e9sence de sympt\u00f4mes d\u2019HF malgr\u00e9 un traitement m\u00e9dicamenteux\u00a0;<\/li>\n<li>Techniques\u00a0: annuloplastie (r\u00e9duction de l\u2019anneau fibreux), reconstruction par lambeau, dans certains cas MitraClip (par correction par cath\u00e9ter).<\/li>\n<\/ul>\n<\/li>\n<li><strong>Assistance circulatoire m\u00e9canique<\/strong> (DACM\u00a0: HeartMate, HeartWare)\u00a0: Indications\u00a0:\n<ul class=\"wp-block-list\">\n<li>HF s\u00e9v\u00e8re (NYHA IV) r\u00e9fractaire au traitement\u00a0;<\/li>\n<li>Candidats \u00e0 une transplantation cardiaque (en tant que pont vers la transplantation cardiaque)\u00a0;<\/li>\n<li>Patients qui ne sont pas \u00e9ligibles \u00e0 une transplantation (dans le cadre d\u2019un traitement de soutien \u00e0 long terme).<\/li>\n<\/ul>\n<\/li>\n<li><strong>Transplantation cardiaque<\/strong>\u00a0:\n<ul class=\"wp-block-list\">\n<li>HF r\u00e9fractaire s\u00e9v\u00e8re (NYHA IIIb-IV)\u00a0;<\/li>\n<li>Inefficacit\u00e9 des m\u00e9dicaments et des dispositifs th\u00e9rapeutiques\u00a0;<\/li>\n<li>D\u00e9clin progressif de la fonction des organes cibles\u00a0;<\/li>\n<li>\u00c2ge g\u00e9n\u00e9ralement inf\u00e9rieur \u00e0 65\u00a0ans, pas de contre-indications absolues\u00a0;<\/li>\n<li>Contre-indications\u00a0: tumeurs malignes (avec mauvais pronostic d\u2019esp\u00e9rance de vie), infections actives, hypertension pulmonaire s\u00e9v\u00e8re, troubles de la compliance.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div>\n<h2 class=\"faq-title h2-article\" id=\"faq\">FAQ<\/h2>\n<div class=\"faq-section\">\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">1. La cardiomyopathie dilat\u00e9e peut-elle \u00eatre compl\u00e8tement gu\u00e9rie\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Pas compl\u00e8tement, mais avec un traitement appropri\u00e9, il est possible d\u2019am\u00e9liorer de mani\u00e8re significative la qualit\u00e9 et la dur\u00e9e de vie.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">2. Quelle est la diff\u00e9rence entre les formes idiopathiques et g\u00e9n\u00e9tiques de la CMD\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">La maladie idiopathique n\u2019a pas de cause identifi\u00e9e\u00a0; la maladie g\u00e9n\u00e9tique est caus\u00e9e par des mutations h\u00e9r\u00e9ditaires.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">3. Pourquoi la CMD peut-elle se d\u00e9velopper chez des personnes ne souffrant pas de maladie cardiaque\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Elle peut \u00eatre caus\u00e9e par des g\u00e8nes cach\u00e9s, des virus, des toxines, des troubles hormonaux ou une surcharge.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">4. Dans quelle mesure la CMD peut-elle \u00eatre mortelle et quelles sont ses principales complications\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">La cardiomyopathie dilat\u00e9e est une maladie potentiellement mortelle qui \u00e9volue en l\u2019absence de traitement, mais un traitement opportun peut r\u00e9duire consid\u00e9rablement les risques. Son danger provient du d\u00e9veloppement de trois complications cl\u00e9s\u00a0: l\u2019insuffisance cardiaque progressive, qui entra\u00eene un dysfonctionnement de plusieurs organes\u00a0; les arythmies ventriculaires malignes, qui provoquent une mort cardiaque subite\u00a0; et les \u00e9v\u00e9nements thromboemboliques, qui peuvent conduire \u00e0 un accident vasculaire c\u00e9r\u00e9bral mortel.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">5. Quels sont les sympt\u00f4mes qui doivent alerter\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Dyspn\u00e9e, \u0153d\u00e8me, fatigue, palpitations cardiaques, \u00e9vanouissement.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">6. La maladie est-elle h\u00e9r\u00e9ditaire\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Oui, jusqu\u2019\u00e0 50\u00a0% des cas pr\u00e9sentent une forme familiale. Un ECG et une \u00e9chographie cardiaque sont recommand\u00e9s pour les proches.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">7. Que signifie \u00ab\u00a0fraction d\u2019\u00e9jection r\u00e9duite\u00a0\u00bb\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Il s\u2019agit d\u2019un indicateur de la fonction de pompage du c\u0153ur. Dans la CMD, elle est r\u00e9duite en raison de l\u2019affaiblissement du muscle cardiaque.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">8. Quand un d\u00e9fibrillateur (DAI) doit-il \u00eatre install\u00e9 dans le cas d\u2019une CMD\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">En cas de r\u00e9duction s\u00e9v\u00e8re de FE (<35\u00a0%) et de risque d\u2019arythmie s\u00e9v\u00e8re.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">9. Peut-on faire du sport en cas de CMD\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Seul un exercice mod\u00e9r\u00e9, convenu avec un cardiologue, est autoris\u00e9.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">10. Peut-on tomber enceinte en cas de CMD\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">C\u2019est possible, mais dans un \u00e9tat stable et sous surveillance m\u00e9dicale stricte\u00a0; les risques d\u00e9pendent de la gravit\u00e9 de la maladie.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">11. Quelles sont les caract\u00e9ristiques de la cardiomyopathie dilat\u00e9e chez l\u2019enfant\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Chez les enfants, la CMD est plus souvent associ\u00e9e \u00e0 une myocardite ant\u00e9rieure ou \u00e0 des syndromes g\u00e9n\u00e9tiques sp\u00e9cifiques. La pr\u00e9sentation clinique peut \u00eatre non sp\u00e9cifique (dyspn\u00e9e, difficult\u00e9s d\u2019alimentation) et le pronostic est souvent plus grave que chez l\u2019adulte.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-block sources-list-hidden\" id=\"references\">\n<div class=\"sources-list-content\">\n<div class=\"sources-list-title\">\n<p class=\"small-text-bold text-black sources-list-title-text\">R\u00e9f\u00e9rences<\/p>\n<div class=\"sources-expand-button-wrapper-mobile\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-items\">\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">1.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Catalogue VOKA. [Ressource \u00e9lectronique] <\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/catalog.voka.io\/<\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">2.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Arbelo E, Protonotarios A, Gimeno JR, et al. 2023 ESC Guidelines for the management of cardiomyopathies (Lignes directrices de l\u2019ESC pour la prise en charge des cardiomyopathies). Eur Heart J. 2023 Oct 1;44(37):3503-3626. doi\u00a0: 10.1093\/eurheartj\/ehad194.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">3.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Heymans S, Lakdawala NK, Tsch\u00f6pe C, Klingel K. Dilated cardiomyopathy: causes, mechanisms, and current and future treatment approaches (Cardiomyopathie dilat\u00e9e\u00a0: causes, m\u00e9canismes et approches th\u00e9rapeutiques actuelles et futures). Lancet. 2023 Sep 16;402(10406):998-1011. doi\u00a0: 10.1016\/S0140-6736(23)01241-2.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">4.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Gigli M, Stolfo D, Merlo M, et al. Pathophysiology of dilated cardiomyopathy: from mechanisms to precision medicine (Physiopathologie de la cardiomyopathie dilat\u00e9e\u00a0: des m\u00e9canismes \u00e0 la m\u00e9decine de pr\u00e9cision). Nat Rev Cardiol. 2025 Mar;22(3):183-198. doi\u00a0: 10.1038\/s41569-024-01074-2.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">5.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Reichart D, Magnussen C, Zeller T, Blankenberg S. Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: A translational review of current literature (Cardiomyopathie dilat\u00e9e\u00a0: des ph\u00e9notypes \u00e9pid\u00e9miologiques aux ph\u00e9notypes g\u00e9n\u00e9tiques, une revue translationnelle de la litt\u00e9rature actuelle). J Intern Med. 2019 Oct;286(4):362-372. doi\u00a0: 10.1111\/joim.12944.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">6.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Peters S, Johnson R, Birch S, et al. Familial Dilated Cardiomyopathy (Cardiomyopathie dilat\u00e9e familiale). Heart Lung Circ. 2020 Apr;29(4):566-574. doi\u00a0: 10.1016\/j.hlc.2019.11.018.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">7.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Harding D, Chong MHA, Lahoti N, et al. Dilated cardiomyopathy and chronic cardiac inflammation: Pathogenesis, diagnosis and therapy (Cardiomyopathie dilat\u00e9e et inflammation cardiaque chronique\u00a0: pathogen\u00e8se, diagnostic et th\u00e9rapie). J Intern Med. 2023 Jan;293(1):23-47. doi\u00a0: 10.1111\/joim.13556.<\/cite><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-expand-button-wrapper\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>La cardiomyopathie dilat\u00e9e (CMD) est une maladie du myocarde caract\u00e9ris\u00e9e par une dilatation (\u00e9largissement) et un dysfonctionnement systolique du ventricule gauche ou des deux ventricules en l&rsquo;absence de maladie coronarienne, de malformations cong\u00e9nitales, d&rsquo;hypertension et d&rsquo;anomalies valvulaires qui pourraient expliquer ces changements. Selon des \u00e9tudes bas\u00e9es sur la population, la pr\u00e9valence de la CMD est [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"template":"","diseases_category":[230],"class_list":["post-1781","diseases_post","type-diseases_post","status-publish","hentry","diseases_category-cardiologie"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.0 (Yoast SEO v26.5) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cardiomyopathie dilat\u00e9e\u00a0: sympt\u00f4mes, causes, pathog\u00e9nie, diagnostic et traitement<\/title>\n<meta name=\"description\" content=\"Cardiomyopathie dilat\u00e9e\u00a0: \u00e9tiologie, pathog\u00e9nie, diagnostic et traitement. 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