Speckle tracking echocardiographic deformation indices in Chagas and idiopathic dilated cardiomyopathy: Incremental prognostic value of longitudinal strain

Abstract

Background Chagas cardiomyopathy (CDC) is associated with a poor prognosis compared to other cardiomyopathies. Speckle tracking echocardiography (STE), which provides direct assessment of myocardial fiber deformation, may be useful in predicting prognosis. Objective This study assessed STE in CDC and compared with idiopathic cardiomyopathy (IDC), and also examined the incremental prognostic information of STE over left ventricular ejection fraction (LVEF) in these patients. Methods We enrolled 112 patients, age of 56.7 ± 11.8 years, 81 with CDC and 31 with IDC. STE indices were obtained at baseline in all patients. The endpoint was a composite of death, hospitalization for heart failure, or need for heart transplantation. Results Patients with IDC had worse LV systolic function compared to CDC, with LVEF of 34.5% vs 41.3%, p = 0.004, respectively. After adjustment for LVEF, there were no differences in STE values between CDC and IDC. During a median follow-up of 18.2 months (range, 11 to 22), 26 patients met the composite end point (24%). LV longitudinal strain was a strong predictor of adverse events, incremental to LVEF and E/e' ratio (HR 1.463, 95% CI 1.130–1.894; p = 0.004). The risk of cardiac events increased significantly in patients with GLS > - 12% (log-rank p = 0.035). Conclusions STE indices were abnormal in patients with dilated cardiomyopathy, without differences between CDC and IDC. LV longitudinal strain was a powerful predictor of outcome, adding prognostic information beyond that provided by LVEF and E/e' ratio.

Two-dimensional strain derived parameters provide independent predictors of progression to Chagas cardiomyopathy and mortality in patients with Chagas disease

“…However, in most of the patients at earlier stages of CD cardiac form the pattern of cardiac fibrosis is midwall [30] , [34] , where circumferentially oriented myofibers predominate [33] . Still, LV-GLS was described as an independent predictor of cardiovascular events in patients with HF due to CD or idiopathic dilated cardiomyopathy [35] . However, this last paper included only patients with HF (stages C and D of CD cardiac form) with a mix of different etiologies.…”

Longitudinal Speckle Tracking Strain Abnormalities in Chagas Disease: A Systematic Review and Meta-Analysis

“…The initial search yielded 1044 studies, from which ten studies met the inclusion criteria ( Figure 1 ) [ 15 , 21 , 22 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. The studies were performed in Brazil (n = 7), Argentina (n = 1), Colombia (n = 1), and Spain (n = 1) from 2008 until 2019.…”

Cardiac Magnetic Resonance in the Assessment of Chagas Disease and its Complications

“…Due to the very low sensitivity of echocardiography in detecting RV systolic dysfunction in patients with CD, speckle-tracking echocardiography has been used in the detection of RV impairment 18 , 19 and the early involvement of the left ventricle (LV) even in patients with preserved LV ejection fractions. [20][21][22] An analysis performed in patients in early stages of CD observed, through CMR, a decrease in global longitudinal and circumferential LV strain only in patients with MF. 23 The emergence of a perfusion CMR sequence allowed physicians to identify myocardial perfusion abnormalities associated with microvascular damage in patients with normal coronary arteries and ischemic-like symptoms.…”