Abstract
Background: Left ventricular (LV) function assessment in patients (pts) with Chagas disease (ChD) is challenging. LV ejection fraction (LVEF) as a marker of myocardial contractility in these pts has issues, and alterations in myocardial deformation (MD) may occur in early stages of cardiac disease (CD) before the decline of LVEF. LV global longitudinal strain (GLS) is a good parameter to evaluate LV MD, but is dependent on afterload. LV myocardial work (MW) is a technique which integrates afterload to the calculation of GLS Purpose: To analyze LV function using MW in pts with ChD Methods: 39 pts with positive serology for ChD, (74,4% women, age 68,8 ± 9,7) followed in a quaternary Brazilian hospital, were divided in groups of stages of CD: G1 - normal Echocardiography (Echo) and ECG, G2 - alterations in ECG a/o Echo, normal LVEF, G3 - reduced LVEF. LV MW was measured integrating GLS with non-invasive blood pressure as an afterload index, for generation of pressure-strain loops by specific software(fig.1). Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured. Results: 11 pts (28,2%) were in G1, 14 (35,9%) in G2, and 14 (35,9%) in G3. In overall population median values of MW were within normal ranges: GWI = 1760mmHg% (>968), GCW = 2046mmHg% (>1550), GWW= 178mmHg% (<331), GWE = 92 (>83). Values of GWI, GCW and GWE were significantly lower and GWW was higher in G3, compared to G1 and G2, translating into less LV mechanical efficiency (ME) in these pts with more advanced CD (table 1). Despite LVEF and GLS similar between G1 and G2, values of GCW were 12% lower in G2 compared to G1, which could point to a tendency of early alterations in these pts, although not reaching statistical significance (p > 0,05). Conclusion: In pts with advanced stages with Chagas CD (G3) there were significant alterations in parameters that evaluate ME, with reduced values of GWI, GCW and GWE, with higher GWW
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