Speckle tracking echocardiography in the indeterminate form of Chagas disease.

BACKGROUND: Chagas disease is one of the most common diseases in Latin-America, and cardiac involvement is a significant cause of death. Assessment of myocardial strain may detect early myocardial damage. OBJECTIVES: To determine differences in longitudinal strain using speckle tracking to assess regional and global left ventricular function in patients with the indeterminate form of Chagas disease, in comparison with a control group. METHODS: This is a retrospective matched case-control study, conducted in a single center. We evaluated 45 adult patients with Chagas disease, diagnosed with 2 serological methods, without evidence of cardiac involvement, who were compared with 45 healthy control subjects, who were sex- and age-matched. All patients underwent Doppler echocardiography and longitudinal strain with speckle tracking. RESULTS: Median age was 59 years, and 60% were female. Echocardiographic parameters were similar in patients with Chagas and control subjects. In patients with Chagas, global strain differed significantly from that of control subjects (-17 vs -20.3, P < .001). Segmental strain showed 7 abnormal segments in patients with Chagas (P < .05). CONCLUSIONS: In patients with the indeterminate form of Chagas disease, global and segmental longitudinal peak systolic strain is reduced compared with healthy subjects, thus suggesting that it could be a sensitive technique to detect early myocardial damage. These findings could provide useful information regarding the pathophysiology of cardiac involvement and understand whether they might have prognostic usefulness or help develop strategies to modify the course and prognosis of patients with Chagas disease. A longitudinal prospective study would be necessary to validate our findings.

Use of tissue doppler imaging for the early detection of myocardial dysfunction in patients with the indeterminate form of Chagas disease

Abstract INTRODUCTION: Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls. METHODS: We compared 194 patients with the indeterminate form of Chagas disease to 72 age-matched healthy individuals. We considered p-values <0.05 to be statistically significant. RESULTS: TDI analysis of the right ventricular (RV) showed lengthened isovolumic relaxation time (IRT) and higher RV index of myocardial performance (RIMP) and left ventricle (LV) index of myocardial performance (LIMP) in the Chagas group than in the control group, indicating RV and LV systolic and diastolic myocardial damage. TDI analysis of the myocardial velocities of the interventricular septum and the lateral wall of the LV also showed a systolic and diastolic myocardial damage. CONCLUSIONS: The study results demonstrated early LV systolic and diastolic myocardial damage in the RV and LV in patients with the indeterminate form of Chagas disease by TDI. These early findings of RV and LV dysfunction may help identify patients who will progress to heart failure during the disease course. TDI should be included in initial patient evaluations because it allows adequate follow-up and treatment.

Utilidad del strain bidimensional longitudinal por speckle tracking en pacientes con enfermedad de Chagas-Mazza sin cardiopatía demostrada / Usefulness of two-dimensional longitudinal strain by speckle tracking in patients with Chagas disease without evident heart disease / Utilidade de strain bidimensional longitudinal por speckle tracking em pacientes com doença de Chagas sem evidência de doença cardíaca

Introducción. La enfermedad de Chagas es una causa importante de insuficiencia cardíaca y su identificación precoz puede ayudar a identificar pacientes en riesgo de progresión de la enfermedad. El strain bidimensional longitudinal (Str2D) podría ser una herramienta útil para detectar disfunción ventricular izquierda incipiente. Objetivos. Analizar si el strain puede detectar alteraciones en pacientes asintomáticos y sin patología demostrable por los métodos convencionales en la enfermedad de Chagas. Materiales y métodos. Estudio transversal de 45 pacientes menores de 65 años de zona rural con enfermedad de Chagas, sin patología demostrada frente a 33 individuos sanos (controles). En todos realizamos serología por dos métodos, examen clínico, electrocardiograma y eco-Doppler cardíaco: diámetro diastólico del ventrículo izquierdo (DDVI), área auricular izquierda (AI), fracción de eyección del ventrículo izquierdo (Fey) por Simpson, excursión sistólica del plano del anillo tricuspídeo (TAPSE), E/A mitral (E/A), E/e', S tisular (S´) de ventrículo izquierdo (VI) y ventrículo derecho (VD), Str2D de cada segmento del VI y strain global. Estadística: variables cuantitativas de distribución normal se compararon mediante test de t y cualitativas con test de chi cuadrado. Variabilidad intra e interobservador por r de Pearson y coeficiente de correlación intraclase.Resultados. Edad, sexo y eco-Doppler convencional (DDVI, Fey, AI, TAPSE, E/A, E/e') no mostraron diferencias estadísticamente significativas. El strain global y el strain de los segmentos apicales del VI evidenciaron diferencias significativas entre pacientes con enfermedad de Chagas sin cardiopatía demostrada (SCD) y controles, aunque dichos valores se encuadran dentro de rangos considerados fisiológicos. Variabilidad intraobservador del strain global (r de Pearson: 0,93 y CCI: 0,93) e interobservador (coeficiente r de Pearson 0,89 y un CCI: 0,88). Conclusiones. Los hallazgos del estudio muestran reducción significativa del strain longitudinal global y distal, compatible con un daño miocárdico incipiente en los pacientes con serología positiva para enfermedad de Chagas sin cardiopatía demostrada, hipótesis de trabajo que sólo el tiempo y un prolijo seguimiento podrán confirmar.

Introduction. Chagas disease is a major cause of heart failure and early identification may help identify patients at risk for disease progression. The two-dimensional longitudinal strain (Str2D) could be a useful tool for detecting incipient left ventricular dysfunction. Objectives. Analyze whether longitudinal dimensional strain can detect abnormalities in asymptomatic patients without demonstrable pathology by conventional methods in Chagas disease. Materials and Methods. Cross-sectional study of 45 patients under age 65 years in an endemic rural area with Chagas disease without proven pathology (non evident cardiopathy: NEC) versus 33 control patients. In all patients study was made by two serologic methods, clinical examination, electrocardiogram and Doppler ultrasound of the heart: diastolic diameter of the left ventricle (LVDD), left atrial area (LAA), left ventricle ejection fraction (Fey) by Simpson, excursion of tricuspid ring (TAPSE), E/A mitral ratio (E/A), E/e' ratio, S tissue (S') of left ventricular (LV) and right ventricular (RV), Str2D of each segment LV and global strain. Statistics: Normal distribution quantitative variables were compared using t test and qualitative variables with chi square test. Intra- and inter-observer variability for r Pearson and intra-class correlation coefficient (ICC). Results. Age, sex and conventional Doppler echocardiography (LVDD, Fey, LAA, TAPSE, E/A, E/e') showed no statistically significant differences. Global strain and strain of the apical LV segments showed significant differences between patients with Chagas disease without proven disease and their controls, although these values fall within ranges considered physiological. Intraobserver variability of global strain (Pearson's r 0.93 and ICC: 0.93) and interobserver (Pearson coefficient r of 0.89 and an ICC: 0.88). Conclusions. In a group of asymptomatic patients with Chagas disease without apparent cardiac involvement (NEC stage), the Str2D was lower compared with healthy individuals, suggesting the existence of subtle myocardial damage in these patients. Hypotheses that only time can confirm and track.

Introdução. A doença de Chagas é uma das principais causas de insuficiência cardíaca e sua identificação precoce pode ajudar a identificar pacientes com risco de progressão da doença. Strain longitudinal bidimensional (Str2D) poderia ser uma ferramenta útil para a detecção de disfunção ventricular esquerda incipiente. Objetivos. Analise se strain longitudinal dimensional pode detectar anormalidades em pacientes assintomáticos, sem patologia demonstrável por métodos convencionais na doença de Chagas. Materiais e métodos. Estudo transversal de 45 pacientes com idade inferior a 65 anos em uma área rural endêmica de doença de Chagas sem comprovada patologia (cardiopatia não evidente: CNE) versus 33 pacientes do grupo controle. Em todos os pacientes do estudo foi feita por dois métodos sorológicos, exame clínico, eletrocardiograma e ultrasom Doppler do coração: diâmetro diastólico do ventrículo esquerdo (DDVE), área do átrio esquerdo (AE), fração de ejeção do ventrículo esquerdo (Fey) por Simpson, excursão de anel tricúspide (TAPSE), relação E/A mitral (E/A), E/e' ratio, S tecido (S') do ventrículo esquerdo (VE) e do ventrículo direito (VD), Str2D de cada segmento VI e strain geral. Estatística: variáveis quantitativas de distribuição normal foram comparadas pelo teste t e qualitativa com o teste qui-quadrado. Variabilidade intra e interobservador para r Pearson e coeficiente de correlação intraclasse (CCI). Resultados. Idade, sexo e ecocardiograma Doppler convencional (DDVI, Fey, AE, TAPSE, E/A, E/e') não mostraram diferenças estatisticamente significativas. Strain global e strain dos segmentos do VE apicais apresentaram diferenças significativas entre os pacientes com doença de Chagas sem doença comprovada e seus controles; embora estes valores caem dentro da faixa considerada fisiológica. Variabilidade intra-observador da strain global (r de Pearson: 0,93 e CCI: 0,93) e inter-observador (coeficiente r de Pearson 0,89 e um CCI: 0,88). Conclusões. Os resultados deste estudo poderiam mostrar uma lesão miocárdica incipiente em pacientes com sorologia positiva para doença de Chagas sem cardiopatia demonstrada. A hipótese de trabalho de que só o tempo e um longo seguimento irão confirmar.