Assessment of health-related quality of life in patients with Chagas cardiomyopathy using Minnesota living with heart failure questionnaire: A validation study.

OBJECTIVE: Chagas cardiomyopathy (ChC) is the most severe clinical form of Chagas disease and, in association with psychosocial factors, can compromise the health-related quality of life (HRQoL) of affected patients. To date, there is no specific instrument to assess the HRQoL of these patients, and the Minnesota Living with Heart Failure Questionnaire (MLwHFQ), specific for heart failure, is being used both in research and current clinical practice. Therefore, we aimed to verify the validity of the MLwHFQ in the assessment of HRQoL of patients with ChC. METHODS: Fifty patients with ChC (50.6 ± 10.1 years, NYHA I-III) were evaluated. The MLwHFQ, Short-Form of Health Survey (SF-36), Beck Depression Inventory (BDI), and Human Activity Profile (HAP) were applied. All patients underwent echocardiography and Cardiopulmonary Exercise Testing (CPET). RESULTS: The MLwHFQ score correlated with almost all SF-36 domains (with r-value ranging from -0.38 to -0.69), except pain (p = 0.118). The MLwHFQ score also correlated with the BDI score (r = 0.748; p < 0.001), HAP score (r = -0.558; p = 0.001), peak oxygen uptake (r = -0.352; p = 0.01), and left ventricular ejection fraction (r = -0.329; p = 0.021). There was no significant difference in the score found on the MLwHFQ among NYHA classes (p = 0.101), as well as between patients with systolic dysfunction (n = 30) and preserved cardiac function (n = 20) (p = 0.058). Similarly, there was no significant difference in the score found on the physical (p = 0.423) and mental (p = 0.858) components of SF-36 between patients with systolic dysfunction and preserved cardiac function (p = 0.271 and p = 0.609, respectively). There was also no difference in the mental component of SF-36 among NYHA classes (p = 0.673). However, the HRQoL using the physical component of SF-36 was worse in advanced NYHA classes (p = 0.014). CONCLUSION: MLwHF correlated with most SF-36 HRQoL domains, depressive symptoms, physical activity, and systolic function and seems to be valid in assessing the HRQoL of ChC patients.

Índices regionais de deformação (Strain/Strain Rate) em neonatos normais / Regional deformation indices (Strain/Strain Rate) in healthy neonates

Introdução: O Doppler tecidual (DT) evoluiu para a determinação da deformação miocárdica regional pela medida do strain rate (SR) e strain (ε) longitudinal (L) e radial (R) unidimensionais. Objetivos: Determinar padrões de normalidade em neonatos nas primeiras 24 horas de vida e estabelecer valores de referência. Casuística e Método: Foram selecionados 55 neonatos, com idade média de 20,14 ± 14,0 horas. Por meio dos cortes apical e paraesternal, em três ciclos cardíacos consecutivos, digitalmente obtidos com taxas de 300 ± 50 ciclos/s, foram realizadas medidas dos componentes sistólico, diastólico inicial e final das curvas de SR/ε, utilizando programa específico. Comparações múltiplas entre paredes e segmentos foram feitas. Resultados: Verificou-se diferença significativa na deformação longitudinal entre as medidas do SR/ε sistólicos do segmento basal da parede septal, em relação à apical (-1,89 ± 0,60, -25,86 ± 4,83 versus -1,66 ± 0,22, -24,23 ± 3,48), P= 0,04 e P= 0,02. A deformação longitudinal regional do VD também não foi homogênea, com diferenças significantes entre os segmentos basal e apical. Os valores absolutos de SR/ε e todos os seus componentes foram maiores na direção R, quando comparados com a L (SR sistólico 2,98 ± 0,78 s-1 versus (-)1,89 ± 0,60 s-1ε sistólico 53,8% ± 19% versus (-) 24,8% ± 3% P< 0,01). A variabilidade interobservador da medida do SR/ε foi de 0,7% e 1,2%, respectivamente. Conclusão: Os índices regionais de deformação miocárdica baseados no Doppler (SR/ε) constituem técnica clínica reproduzível em neonatos, permitindo a análise da função regional em diferentes segmentos do VE e VD. Representam parâmetros novos, não invasivos e independentes da interpretação visual, podendo ser utilizados no diagnóstico de acometimento cardíaco do neonato.

Quantification of regional left and right ventricular deformation indices in healthy neonates by using strain rate and strain imaging.

BACKGROUND: Color Doppler myocardial imaging (CDMI) allows the calculation of local longitudinal or radial strain rate (SR) and strain (epsilon). The aims of this study were to determine the feasibility and reproducibility of longitudinal and radial SR and epsilon in neonates during the first hours of life and to establish reference values. METHODS: Data were obtained from 55 healthy neonates (29 male; mean age, 20 +/- 14 hours; mean birth weight, 3,174 +/- 374 g). Apical and parasternal views quantified regional longitudinal and radial SR and epsilon in differing ventricular wall segments. Values at peak systole, early diastole, and late diastole were calculated from the extracted curves. CDMI data acquired at 300 +/- 50 frames/s were analyzed offline. Three consecutive cardiac cycles were measured during normal respiration. The timing of specific systolic or diastolic regional events was determined. Multiple comparisons between walls and segments were made. RESULTS: Left ventricular (LV) longitudinal deformation showed basal differences compared with apical segments within one specific wall. Right ventricular (RV) longitudinal deformation was not homogeneous, with significant differences between basal and apical segments. Longitudinal epsilon values were higher in the RV free basal and middle wall segments compared with the left ventricle. In the RV free wall apical segment, longitudinal SR and epsilon were maximal. LV systolic SR and epsilon values were higher radially compared with longitudinally (radial peak systolic SR midportion, 2.9 +/- 0.6 s(-1); radial peak systolic epsilon, 53.8 +/- 19%; longitudinal peak systolic SR midportion, -1.8 +/- 0.5 s(-1); longitudinal peak systolic epsilon, -24.8 +/- 3%; P < .01). Longitudinal systolic epsilon and SR interobserver variability values were 1.2% and 0.7%, respectively. CONCLUSION: Ultrasound-based SR and epsilon imaging is a practical and reproducible clinical technique in neonates, allowing the calculation of regional longitudinal and radial deformation in RV and LV segments. These regional SR and epsilon indices represent new, noninvasive parameters that can quantify normal neonate regional cardiac function. Independent from visual interpretation, they can be used as reference values for diagnosis in ill neonates.