Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy

Abstract

BackgroundChagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks.ObjectiveTo assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions.Methods10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging.ResultsReservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e’average with the reservoir and pump functions (TEF and AEF), and a positive correlation of e’average with s’ wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions.ConclusionAn impairment of LA functions in Chagas cardiomyopathy was observed.

WHF Recommendations for the Use of Echocardiography in Chagas Disease

“…Diastolic dysfunction contributes to left atrium (LA) remodeling and dysfunction, particularly in patients with LV dysfunction [8,36,49]. Measurement of LA volume (LAV) and indexing it to body surface area (LAVi) has been demonstrated to be a marker of duration and severity of diastolic dysfunction.…”

“…It is also useful in Chagas disease patients to predict prognosis. Left atrium volume can be increased in all stages of ChD [36,49,50], and LA function seems to be more significantly compromised in ChD than in idiopathic cardiomyopathy [51], suggesting a component of atrial myopathy. However, a study using strain to analyze atrial function demonstrated impairment to a degree similar to that of idiopathic dilated cardiomyopathy [52].…”

Atualização no diagnóstico por imagem da miocardiopatia chagásica: uma revisão bibliográfica

“…O comprometimento das funções de reservatório, conduto e bomba do átrio esquerdo foram frequentes em pacientes com miocardiopatia chagásica e disfunção sistólica de VE. Enquanto os pacientes com função sistólica normal não tiveram alterações dos parâmetros de átrio esquerdo (FRAGATA et al, 2015) Quando comparado ao gênero evidenciou o que o sexo masculino possui acometimento maior da fibrose miocárdica e pior remodelamento ventricular ao método de ressonância magnética. Esta ainda evidenciou maior sensibilidade em relação a ecocardiografia na avaliação da fração de ejeção do ventrículo direito.…”

Hypotension and Renal Dysfunction: The Ghosts of Heart Failure

“… 13 , 14 In our experience, creatinine, in these cases, usually falls at the end of hospitalization or about 30 days after discharge. 14 , 15 In other words, elevated creatinine at admission appears to be a reflection of congestion of the renal veins and transient increases are a consequence of the volume reduction process. Congestion, regardless of worsening of renal function, is associated with worse prognosis.…”