Two-dimensional strain derived parameters provide independent predictors of progression to Chagas cardiomyopathy and mortality in patients with Chagas disease

Abstract

Background Patients with chronic Chagas disease (CD) cardiomyopathy have a high mortality. We evaluated if two-dimensional (2D) strain ( ε ) parameters provide independent predictors of progression to CD cardiomyopathy and all-cause mortality. Methods A total of 408 patients with chronic CD (58.6% women; 53 ± 11 years; clinical forms: indeterminate 34.1%, cardiac 57.6%, digestive 1.2%, cardiodigestive 7.1%) were consecutively included in this single-center prospective longitudinal study. Echocardiographic evaluation included left atrial and left ventricular (LV) function on ε analyses. Primary end-point was a composite of all-cause mortality or heart transplant. Secondary end-point was CD progression defined as the occurrence of changes typical of CD in electrocardiogram, sustained ventricular tachycardia, wall motion abnormalities, or heart failure among patients with the indeterminate form at baseline. Multivariable Cox-proportional-hazards regression analyses were performed to test if 2D ε parameters were associated with the studied end-points. P values < 0.05 were considered significant. Results The primary end-point occurred in 91 patients after a follow-up of 6.5 ± 2.7 years. CD progression occurred in 26 out of 144 patients without cardiac form at baseline (2.88 cases/100 patient-years). Peak LV circumferential (HR 1.09, 95% CI 1.01–1.18, P = .02) and radial (HR 0.97, 95% CI 0.95–0.99, P = .007) ε , and LV torsion (HR 0.51, 95% CI 0.35–0.74, P = .0004) were independent predictors of the primary end-point. Peak LV radial ε (HR 0.96, 95% CI 0.93–0.99, P = .03) was an independent predictor of CD progression. Conclusions Therefore, 2D ε derived parameters can be useful for CD progression and mortality prediction.

Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): A study protocol for a randomized clinical trial

“…Approximately 50-70% of individuals with chronic CD present the indeterminate form of the disease, characterized by parasitological and/or serological evidence of T. cruzi infection, but absence of major clinical signs and symptoms, normal electrocardiogram, and normal chest, esophagus and colon 10.3389/fmed.2022.1087188 X-rays (7,8). However, the indeterminate form can progress to the determinate forms of CD, with an estimated annual progression rate of 1.9% (9,10). Most infected individuals will remain in the indeterminate form for the rest of their life, with a benign prognosis (4, 11,12).…”

“…However, subclinical abnormalities have also been observed in patients with indeterminate form of CD in comparison to those without CD, including early cardiac abnormalities (e.g., greater fibrosis mass) (13, 14), changes in biomarkers of the inflammatory profile and cardiac function (15)(16)(17), and alterations of autonomic modulation (18)(19)(20)(21). The prognostic value of most of these early subclinical abnormalities is still not determined, although a recent study that evaluated parameters derived from two-dimensional strain provided independent predictors progression to Chagas cardiomyopathy in patients with the indeterminate form of CD (10).…”

Biomarkers and Echocardiographic Predictors of Cardiovascular Outcome in Patients With Chronic Chagas Disease

“… 36 Insertion of a new cardiac device and use of cardiovascular medications followed Brazilian guidelines. 6 Patients were followed as previously described 29 until December 2021.…”

“…LA ε was determined as previously described 29 using apical 4‐ and 2‐chamber views. The onset of the P wave was used as the reference point, and peak positive global LA ε, peak negative global LA ε (LASct), and the sum of those previous values were obtained.…”

“… 23 Other traditional 2‐dimensional (2D) Doppler echocardiographic parameters, such as LV diastolic function, 24 , 25 left atrial (LA) volume 26 and function, 25 and right ventricular (RV) function 27 were also described to be predictors of poor cardiovascular outcomes in CD. More recently, speckle tracking echocardiography (STE) enabled the study of myocardial contractility and independent prognostic value of LV global longitudinal strain (LV‐GLS), 28 LV global circumferential strain (LV‐GCS), and LV global radial strain and LV torsion 29 to predict cardiovascular events in CD were reported. In regard to biomarkers, brain natriuretic peptide (BNP), 21 and its pro form, 30 , 31 and high‐sensitivity troponin T 31 have been shown to have prognostic value, together with other biomarkers that can indicate an inflammatory profile, such as transforming growth factor β1 (TGF‐β1), 20 and matrix metalloproteinase (MMP).…”