Echocardiographic parameters, speckle tracking, and brain natriuretic peptide levels as indicators of progression of indeterminate stage to Chagas cardiomyopathy

Abstract

Background Chronic Chagas cardiomyopathy (CCM) is characterized by a unique type of cardiac involvement. Few studies have characterized echocardiographic (Echo) transitions from the indeterminate Chagas disease (ChD) form to CCM. The objective of this study was to identify the best cutoffs in multiple Echo parameters, speckle tracking, and N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) to distinguish patients without CCM (stage A) vs patients with myocardial involvement (stages B, C, or D). Methods Cross‐sectional study conducted in 273 consecutive patients with different CCM stages. Echo parameters, NT‐proBNP, and other clinical variables were measured. Logistic regression models (dichotomized in stage A versus B, C, and D) adjusted for age, sex, body mass index, and NT‐proBNP were performed. Results Left ventricular global longitudinal strain (LV‐GLS), mitral flow E velocity, LV mass index, and NT‐proBNP identified early changes that differentiated stages A vs B, C, and D. The LV‐GLS with a cutoff −20.5% showed the highest performance (AUC 92.99%; accuracy 84.56% and negative predictive value (NPV) 88.82%), which improved when it was additionally adjusted by NT‐proBNP with a cutoff −20.0% (AUC 94.30%; accuracy 88.42% and NPV 93.55%). Conclusions Our findings suggest that Echo parameters and NT‐proBNP may be used as diagnostic variables in detecting the onset of myocardial alterations in patients with the indeterminate stage of ChD. LV‐GLS was the more accurate measurement regarding stage A differentiation from the stages B, C, and D. Prospective longitudinal studies are needed to validate these findings.

Early impairment of myocardial deformation assessed by regional speckle-tracking echocardiography in the indeterminate form of Chagas disease without fibrosis detected by cardiac magnetic resonance

“…It is important to emphasize that the results of our study, reinforcing previous data which showed that LV global myocardium deformation strain indexes GLS and GCS are still preserved in presumably early phases of CD [22,24,25], are indirectly corroborated by a more recent cross-sectional study in patients with different Chagas cardiomyopathy stages by Echeverría et al They also reported that a GLS value with a cut-off of -20.5% could detect the onset of myocardial alterations, despite the fact that this is not a low value of normality in most dedicated software [35].…”

Preventing heart failure: a position paper of the Heart Failure Association in collaboration with the European Association of Preventive Cardiology

“…In the absence of initial cardiac manifestations in infected patients, a yearly follow‐up of cardiac symptoms and electrocardiogram (ECG) seems essential: abnormalities should prompt cardiac work‐up, including echocardiography and ECG monitoring. If available, echocardiography to detect LV abnormalities is preferable, since the ECG is normal in about ∼10% of patients with LV abnormalities 112 …”

Longitudinal strain by speckle tracking and echocardiographic parameters as predictors of adverse cardiovascular outcomes in chronic Chagas cardiomyopathy

“…Multiple studies have found that patients in the indeterminate form may show incipient cardiac damage documented by abnormal longitudinal and radial strain of the LV compared to healthy controls [16,31]. Moreover, radial, circumferential, and longitudinal LV speckle-tracking strain values have been correlated with disease progression and the degree of myocardial fibrosis as measured by cardiac magnetic resonance imaging, highlighting the utility of this diagnostic method in CD and CCM [30,32]. In addition, speckle tracking strain has been shown to have clinical relevance in the prognostic assessment of patients with heart failure independently of LVEF.…”

“…At first, speckle tracking strain has the capacity of identifying subclinical myocardial dysfunction even in individuals with CD without symptoms, ECG, or conventional echocardiographic abnormalities (the so-called indeterminate form of the disease) [30]. Multiple studies have found that patients in the indeterminate form may show incipient cardiac damage documented by abnormal longitudinal and radial strain of the LV compared to healthy controls [16,31].…”