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

Abstract

To analyze the prognostic value of left ventricular global longitudinal strain (LV-GLS) and other echocardiographic parameters to predict adverse outcomes in chronic Chagas cardiomyopathy (CCM). Prospective cohort study conducted in 177 consecutive patients with different CCM stages. Transthoracic echocardiography measurements were obtained following the American Society of Echocardiography recommendations. By speckle-tracking echocardiography, LV-GLS was obtained from the apical three-chamber, apical two-chamber, and apical four-chamber views. The primary composite outcome (CO) was all-cause mortality, cardiac transplantation, and a left ventricular assist device implantation. After a median follow-up of 42.3 months (Q1 = 38.6; Q3 = 52.1), the CO incidence was 22.6% (95% CI 16.7–29.5%, n = 40). The median LV-GLS value was − 13.6% (Q1 = − 18.6%; Q3 = − 8.5%). LVEF, LV-GLS, and E/e′ ratio with cut-off points of 40%, − 9, and 8.1, respectively, were the best independent CO predictors. We combined these three echocardiographic markers and evaluated the risk of CO according to the number of altered parameters, finding a significant increase in the risk across the groups. While in the group of patients in which all these three parameters were normal, only 3.2% had the CO; those with all three abnormal parameters had an incidence of 60%. We observed a potential incremental prognostic value of LV-GLS in the multivariate model of LVEF and E/e′ ratio, as the AUC increased slightly from 0.76 to 0.79, nevertheless, this difference was not statistically significant (p = 0.066). LV-GLS is an important predictor of adverse cardiovascular events in CCM, providing a potential incremental prognostic value to LVEF and E/e′ ratio when analyzed using optimal cut-off points, highlighting the potential utility of multimodal echocardiographic tools for predicting adverse outcomes in CCM.

Cardiac Abnormalities in a Predictive Mouse Model of Chagas Disease

“…Electrocardiography (ECG) has played a key role in CD patient evaluation and management [9,10]. It represents a low-cost diagnostic method and can be predictive of CCC outcomes [11,12].…”

Biomarkers and Echocardiographic Predictors of Cardiovascular Outcome in Patients With Chronic Chagas Disease

“…A study that enrolled 177 patients and studied a combined outcome of all‐cause mortality, heart transplant, or LV assist device implantation described that LV‐GLS, LV ejection fraction, and peak early wave diastolic filling velocity to early diastolic mitral annulus velocity ratio were the best outcome predictors. 28 However, the comparison with our results is difficult, because the variables that were included in the multivariate models were not clear, and some continuous echocardiographic variables were analyzed as dichotomic variables. Another smaller study that included 72 patients who were followed for 60 months for the occurrence of hospitalization for HF, complex ventricular arrhythmias, heart transplant, and all‐cause mortality described that 2D LV‐GLS, 2D LV‐GCS, 3‐dimensional LV area strain, and RV‐GLS were univariable predictors of the studied composite end point.…”

“… 23 Other traditional 2‐dimensional (2D) Doppler echocardiographic parameters, such as LV diastolic function, 24 , 25 left atrial (LA) volume 26 and function, 25 and right ventricular (RV) function 27 were also described to be predictors of poor cardiovascular outcomes in CD. More recently, speckle tracking echocardiography (STE) enabled the study of myocardial contractility and independent prognostic value of LV global longitudinal strain (LV‐GLS), 28 LV global circumferential strain (LV‐GCS), and LV global radial strain and LV torsion 29 to predict cardiovascular events in CD were reported. In regard to biomarkers, brain natriuretic peptide (BNP), 21 and its pro form, 30 , 31 and high‐sensitivity troponin T 31 have been shown to have prognostic value, together with other biomarkers that can indicate an inflammatory profile, such as transforming growth factor β1 (TGF‐β1), 20 and matrix metalloproteinase (MMP).…”

Left Ventricular Function and Myocardial Longitudinal Strain Analysis in Patients with Chagas Disease: Case Series and Systematic Literature Review

“…Assessment of STE along with conventional echocardiography has shown to detect subclinical left ventricular myocardial strain abnormalities even before a profound reduction in Left ventricular ejection fraction (LVEF) in Chagas cardiomyopathy [15,16]. This technique emerges as a significant predictor of adverse cardiovascular events in patients with the indeterminate form of the disease [17].…”