Right Ventricular Doppler Echocardiographic Study of Indeterminate Form of Chagas Disease

Abstract

BackgroundPatients with indeterminate form of Chagas disease/cardiac normality (ICD/CN) exhibited normal electrocardiograms and chest X-rays; however, more sophisticated tests detected some degree of morphological and functional changes in the heart.ObjectiveTo assess the prevalence of systolic and diastolic dysfunction of the right ventricle (RV) in patients with ICD/CN.MethodsThis was a case–control and prevalence study. Using Doppler two-dimensional echocardiography (2D), 92 patients were assessed and divided into two groups: group I (normal, n = 31) and group II (ICD/CN, n = 61).ResultsThe prevalence of RV systolic dysfunction in patients in groups I and II was as follows: fractional area change (0.0% versus 0.6%), mobility of the tricuspid annulus (0.0% versus 0.0%), and S-wave tissue Doppler (6.4% versus 26.0%, p = 0.016). The prevalence of global disorders such as the right myocardial performance index using tissue Doppler (16.1% versus 27.8%, p = 0.099) and pulsed Doppler (61.3% versus 68%, p = 0.141) and diastolic disorders such as abnormal relaxation (0.0% versus 6.0%), pseudonormal pattern (0.0% versus 0.0%), and restrictive pattern (0.0% versus 0.0%) was not statistically different between groups.ConclusionThe prevalence of RV systolic dysfunction was estimated to be 26% (S wave velocity compared with other variables), suggesting incipient changes in RV systolic function in the ICD/CN group.

Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC)

“…However, early abnormalities have been described even in the indeterminate form, such as shortening of the RV isovolumetric contraction time or low RV s 0 on Doppler tissue imaging. 117,118 Moreover, RV Tei index provides incremental prognostic information to that of more traditional risk factors, such as New York Heart Association functional class and LV function. 116 The value of RV strain is still unclear in ChD.…”

Imaging Diagnosis of Right Ventricle Involvement in Chagas Cardiomyopathy

“…Moreover, in this study, only patients with some degree of left ventricle dilatation or systolic dysfunction were included, which, per se, makes the investigational task of finding isolated RV early involvement unfeasible. Furtado et al also investigated the prevalence of RV systolic and diastolic dysfunction including its global performance index in a group of 60 subjects without evidence of cardiac disease by conventional diagnostic methods [ 49 ]. In contrast to the results of Nunes et al, the authors found a 26% prevalence of RV systolic dysfunction when using tissue Doppler systolic tricuspid velocity wave (S′).…”

“…Other publications also addressed the potential of echocardiographic conventional parameters such as S ′, TAPSE, and MPI to detect right ventricular dysfunction in more advanced stages of disease and symptomatic patients [ 69 ]. Some publications also endorsed the ability of echocardiographic parameters to detect right ventricle dysfunction even in patients with the indeterminate form of the disease using tissue Doppler techniques [ 49 , 70 ]. However, using myocardium performance index (MPI), investigators were not able to differentiate patients with the indeterminate form of CD from controls [ 49 ].…”

“…Some publications also endorsed the ability of echocardiographic parameters to detect right ventricle dysfunction even in patients with the indeterminate form of the disease using tissue Doppler techniques [ 49 , 70 ]. However, using myocardium performance index (MPI), investigators were not able to differentiate patients with the indeterminate form of CD from controls [ 49 ]. Also, using 2D speckle tracking, Barbosa et al, in a study of biventricular function, published negative results of strain evaluation to differentiate patients with indeterminate form of CD from controls [ 50 ].…”

Avaliação da deformação miocárdica do ventrí­culo esquerdo pela técnica ecocardiográfica de speckle tracking em um modelo experimental animal de doença de Chagas

“…Nossos resultados mostram acometimento precoce dessa câmara cardíaca, corroborando achados prévios de estudos experimentais e estudos clínicos que utilizaram diferentes métodos de imagem. Um estudo com ecocardiografia demonstrou valores reduzidos de mudança fracional da área do ventrículo direito em pacientes com a forma indeterminada da doença de Chagas em comparação a um grupo controle(101). Estudos anteriores utilizando ventriculografia radioisotópica demonstraram envolvimento do ventrículo direito em fases iniciais da evolução da doença de Chagas, mesmo na presença de função sistólica normal do ventrículo esquerdo(66,102).…”