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.
Highlights
Chagas disease, or American trypanosomiasis, is an infectious disease endemic in Latin America caused by hemoparasite Trypanosomacruzi (T. cruzi) [1]
The levels of the biomarker increased with more severe forms of diastolic dysfunction, being significantly different across DD groups (Supplementary Table 1, Figure 1)
Most of the evaluated biomarkers were significantly correlated with diastolic function echocardiographic variables, being the NT-proBNP and the Cys-C the biomarkers with the highest correlation values across the assessed variables (Supplementary Table 2)
Summary
American trypanosomiasis, is an infectious disease endemic in Latin America caused by hemoparasite Trypanosomacruzi (T. cruzi) [1]. Heart failure in the context of Chagas disease has been related to a predominant systolic dysfunction profile [11, 12]; diastolic dysfunction (DD) in the setting of CCM has been associated with a worse clinical status and a higher incidence of adverse cardiovascular outcomes [13,14,15,16]. This highlights the importance of making a prompt diagnosis of DD, which is usually achieved by echocardiography [17, 18].
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