Abstract
BackgroundChagas cardiomyopathy (CDC) is associated with a poor prognosis compared to other cardiomyopathies. Speckle tracking echocardiography (STE), which provides direct assessment of myocardial fiber deformation, may be useful in predicting prognosis.ObjectiveThis study assessed STE in CDC and compared with idiopathic cardiomyopathy (IDC), and also examined the incremental prognostic information of STE over left ventricular ejection fraction (LVEF) in these patients.MethodsWe enrolled 112 patients, age of 56.7 ± 11.8 years, 81 with CDC and 31 with IDC. STE indices were obtained at baseline in all patients. The endpoint was a composite of death, hospitalization for heart failure, or need for heart transplantation.ResultsPatients with IDC had worse LV systolic function compared to CDC, with LVEF of 34.5% vs 41.3%, p = 0.004, respectively. After adjustment for LVEF, there were no differences in STE values between CDC and IDC. During a median follow-up of 18.2 months (range, 11 to 22), 26 patients met the composite end point (24%). LV longitudinal strain was a strong predictor of adverse events, incremental to LVEF and E/e' ratio (HR 1.463, 95% CI 1.130–1.894; p = 0.004). The risk of cardiac events increased significantly in patients with GLS > - 12% (log-rank p = 0.035).ConclusionsSTE indices were abnormal in patients with dilated cardiomyopathy, without differences between CDC and IDC. LV longitudinal strain was a powerful predictor of outcome, adding prognostic information beyond that provided by LVEF and E/e' ratio.
Highlights
Chagas disease continues to be one of the most prevalent infectious diseases in Latin America, and has become a public health concern in non-endemic countries [1, 2]
After adjustment for left ventricular ejection fraction (LVEF), there were no differences in Speckle tracking echocardiography (STE) values between Chagas dilated cardiomyopathy (CDC) and idiopathic dilated cardiomyopathy (IDC)
left ventricular (LV) longitudinal strain was a strong predictor of adverse events, incremental to LVEF and E/e’ ratio
Summary
Chagas disease continues to be one of the most prevalent infectious diseases in Latin America, and has become a public health concern in non-endemic countries [1, 2]. Chagas cardiomyopathy is associated with poor prognosis with higher mortality rates compared with other causes of heart failure [5,6,7,8]. A previous study showed that the patients with Chagas dilated cardiomyopathy (CDC) had worse survival than those with idiopathic dilated cardiomyopathy (IDC), independent of well-established prognostic of outcome in heart failure [8]. Previous studies with cardiac magnetic resonance (CMR) have demonstrated that myocardial fibrosis is associated with impairment of systolic function, abnormal remodeling, and increased ventricular stiffness [10, 11]. A study demonstrated that left ventricular (LV) fibrosis assessed by CMR is independently related to major advserse cardiac events in patients with Chagas disease [12]. Speckle tracking echocardiography (STE), which provides direct assessment of myocardial fiber deformation, may be useful in predicting prognosis
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