Radionuclide esophageal transit scintigraphy in chronic indeterminate and cardiac forms of Chagas disease

Abstract

Objectives This study was designed to investigate digestive and heart associations, using esophageal transit scintigraphy in three different groups: patients exclusively with the dilated cardiac form of Chagas disease (DCCh), an indeterminate form of Chagas disease, and healthy controls. As a hypothesis, we assumed that autonomic chagasic denervation is a global process. Materials and methods Twenty healthy controls and 75 outpatients with Chagas disease, divided into indeterminate form (n = 33) and (DCCh, n = 42), underwent esophageal scitigraphy. The esophageal transit time (ETT) and percentage of esophageal emptying (%EE) were analyzed by group and correlated with left ventricular ejection fraction (LVEF). Results ETT alterations were found in 57% of indeterminate form and 80% of DCCh. The observed values of ETT and %EE in Chagas disease groups were significantly different from the controls (P-value <0.001). The lowest median ETT was observed for the controls (median = 8.0), followed by indeterminate form (median = 16.5) and DCCh (median = 60.0). Regarding %EE, a higher median value was observed for the controls (median = 92.3), followed by indeterminate form (median = 86.7) and DCCh (median = 56.9). In the DCCh group, ETT and %EE were significantly correlated with LVEF values (r = 0.398; P = 0.015) and (r = 0.475; P = 0.003), respectively. Conclusion An association between left ventricular systolic dysfunction and functional esophageal alterations was observed which was interpreted as indirect evidence of concomitance of gastrointestinal and cardiac disorders. We also found that the greater the impairment of the esophagus’s autonomic function, the worse the cardiac dysfunction.