Assessment of speckle tracking strain predictive value for myocardial fibrosis in subjects with Chagas disease

Abstract

BackgroundOne of the most challenging issues of chronic Chagas disease is to provide earlier detection of heart involvement. Two-dimensional speckle tracking (2-D ST) echocardiography, a new imaging modality with useful applications in several cardiac diseases, has been validated for subjects with myocardial infarction against cardiac magnetic resonance (CMR). Here we hypothesize that the longitudinal global strain (LGS) has an incremental value to ejection fraction for predicting myocardial fibrosis in subjects with Chagas disease.MethodsThis observational study comprised 58 subjects with Chagas disease, confirmed by two positive serologic tests. All subjects underwent conventional Doppler echocardiogram plus speckle tracking strain, and cardiac magnetic resonance.ResultsThe ROC curve analysis revealed that both LGS (area under the curve: 0.78, p = 0.001) and ejection fraction (area under the curve: 0.82, p < 0.001) were significant predictors of myocardial fibrosis. Regarding the percentage of fibrosis, a high correlation was observed with both ejection fraction assessed by echocardiography (r = 0.70, p < 0.001) and LGS (r = 0.64, p < 0.001). However, when adjusted through multiple linear regression, the LGS lost statistical significance as a predictor of myocardial fibrosis (p = 0.111).ConclusionsLGS has no incremental value to conventional ejection fraction measurement in the prediction of myocardial fibrosis in subjects with Chagas disease.

A therapeutic vaccine prototype induces protective immunity and reduces cardiac fibrosis in a mouse model of chronic Trypanosoma cruzi infection

“…In the model described in this manuscript mice developed significant cardiac fibrosis, which is a hallmark of chronic determinate disease in humans [35, 48]. Further, it has been shown that up to 72% of patients in the clinically silent chronic indeterminate phase have evidence of cardiac fibrosis [49], thus the mouse model described here does mimic a key component of human disease and can be used to screen novel therapies for efficacy prior to advancing to human studies. One limitation of this model is the overall low level of cardiac inflammation, which is a key finding in human cases of CCC [47].…”

Chagas Disease and Heart Failure: An Expanding Issue Worldwide

“…Assessment of myocardial strain through speckle tracking could help to detect myocardial damage in early periods of the disease, and some authors describe decreased global radial strain during the indeterminate stage, even in patients with a normal ECG and common echocardiogram. [57–59] Left ventricular global dysfunction with low ejection fraction is one of the most important predictors of death in ChCM. [57,59–61]…”

“…[57–59] Left ventricular global dysfunction with low ejection fraction is one of the most important predictors of death in ChCM. [57,59–61]…”

Advanced Imaging in Chagas Heart Disease: from diagnosis to sudden death risk stratification.

“…In other studies lower values of GLS have been identified in patients with late gadolinium enhancement (LGE) assessed by CMR, however they correlate poorly, and the addition of GLS to EF, showed no incremental benefit to identify patients with LGE. 24 An example of STE in a patient with CHD is shown in Figures 1 and 2.…”