Cardiovascular Biomarkers and Diastolic Dysfunction in Patients With Chronic Chagas Cardiomyopathy

Abstract

Background: Chronic Chagas Cardiomyopathy is a unique form of cardiomyopathy, with a significantly higher mortality risk than other heart failure etiologies. Diastolic dysfunction (DD) plays an important role in the prognosis of CCM; however, the value of serum biomarkers in identifying and stratifying DD has been poorly studied in this context. We aimed to analyze the correlation of six biochemical markers with diastolic function echocardiographic markers and DD diagnosis in patients with CCM.Methods: Cross-sectional study of 100 adults with different stages of CCM. Serum concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), high-sensitivity troponin T (hs-cTnT), soluble (sST2), and cystatin-C (Cys-c) were measured. Tissue Doppler imaging was used to measure echocardiographic parameters indicating DD. Multivariate logistic regression models adjusted by age, sex, BMI, and NYHA classification were used to evaluate the association between the biomarkers and DD.Results: From the total patients included (55% male with a median age of 62 years), 38% had a preserved LVEF, but only 14% had a normal global longitudinal strain. Moreover, 64% had a diagnosis of diastolic dysfunction, with most of the patients showing a restrictive pattern (n = 28). The median levels of all biomarkers (except for sST2) were significantly higher in the group of patients with DD. Higher levels of natural log-transformed NTproBNP (per 1-unit increase, OR = 3.41, p < 0.001), Hs-cTnT (per 1-unit increase, OR = 3.24, p = 0.001), NGAL (per 1-unit increase, OR = 5.24, p =0.003), and Cys-C (per 1-unit increase, OR = 22.26, p = 0.008) were associated with increased odds of having diastolic dysfunction in the multivariate analyses. Finally, NT-proBNP had the highest AUC value (88.54) for discriminating DD presence.Conclusion: Cardiovascular biomarkers represent valuable tools for diastolic dysfunction assessment in the context of CCM. Additional studies focusing mainly on patients with HFpEF are required to validate the performance of these cardiovascular biomarkers in CCM, allowing for an optimal assessment of this unique population.

The role of endosarcomeric cytoskeleton proteins in the mechanisms of left ventricular diastolic dysfunction: focus on titin

“…Диастолическая дисфункция (ДД) левого желудочка (ЛЖ) нередко обозначается как ключевое звено сердечно-сосудистого континуума, завершающегося развитием клинически выраженной хронической сердечной недостаточности (ХСН) не только при повсеместно распространенных болезнях сердца и сосудов (ишемическая болезнь сердца, артериальная гипертензия) [1][2][3][4][5][6], но и при экзотической для многих регионов мира патологии, в частности эндемических заболеваниях паразитарной природы (например, болезни Шагаса и описторхозе) [7][8][9][10][11].…”

Biomarcadores na cardiomiopatia chagásica como preditores diagnóstico, risco e prognóstico atualizações e associações

“…A combinação de NT-proBNP e hs-TnT acima dos respectivos valores de corte está associada a um aumento de 3 vezes no risco de CO entre pacientes com cardiomiopatia chagásica crônica. A utilização de biomarcadores cardíacos pode melhorar a avaliação prognóstica desses39 .Echeverría et al (2021) 40 analisaram a correlação de seis biomarcadores, com marcadores ecocardiográficos da função diastólica e diagnóstico da disfunção diastólica em pacientes com cardiomiopatia chagásica, realizou-se um estudo transversal com 100 pacientes em diferentes estágios da CCM. Foram medidas as concentrações séricas de peptídeo natriurético tipo pró-B amino-terminal (NT-proBNP), galectina-3 (Gal-3), lipocalina associada à gelatinase de neutrófilos (NGAL), troponina T de alta sensibilidade (hs-cTnT), ST2 solúvel (sST2 ) e cistatina-C (Cys-c).…”

“…Igualmente, os níveis dos biomarcadores aumentaram nos pacientes que apresentavam as formas mais graves de disfunção diastólica, sendo significativamente diferente entre os grupos DD. A maioria dos biomarcadores avaliados se correlacionou significativamente com as variáveis ecocardiográficas de função diastólica, sendo o NT-proBNP e o Cys-C os biomarcadores com os maiores valores de correlação entre as variáveis avaliadas40 . É importante ressaltar que este é o primeiro estudo a avaliar biomarcadores anteriormente investigados, diversificando metodologicamente e adicionando novos potenciais biomarcadores.CONSIDERAÇÕES FINAISOs estudos aqui revisados apresentaram evidências importantes quanto à utilização de biomarcadores como instrumentos auxiliadores na busca da compreensão e elucidação dos aspectos clínicos e fisiopatológicos da cardiomiopatia chagásica, agregando ao conhecimento científico.…”