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[Asymptomatic Chagas disease. Electrocardiographic and echocardiographic findings]
D G Rigou1, N Gullone, L Carnevali
1Servicio de Cardiología y de Hemoterapia, Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina.
Insights
Echocardiogram and Doppler are more effective than electrocardiograms for detecting cardiac issues in asymptomatic Chagas disease patients. These imaging techniques reveal abnormalities even when electrocardiograms appear normal, aiding early diagnosis.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Chagas disease, caused by Trypanosoma cruzi, often presents an asymptomatic indeterminate phase.
- Cardiac involvement is a major cause of morbidity and mortality in Chagas disease.
- Early detection of cardiac complications is crucial for managing Chagas disease.
Purpose of the Study:
- To evaluate the diagnostic utility of echocardiography and Doppler ultrasound in identifying cardiac abnormalities in asymptomatic Chagas disease patients.
- To compare the effectiveness of echocardiography and Doppler with electrocardiography in detecting subclinical cardiac involvement.
Main Methods:
- A case-control study involving 70 asymptomatic Chagas disease patients and a control group of healthy blood donors.
- Electrocardiogram (ECG) and echocardiogram with Doppler assessments were performed on all participants.
- Comparison of diagnostic findings between the Chagasic group and the control group.
Main Results:
- Electrocardiogram abnormalities were found in 17.4% of Chagasic patients, primarily left anterior hemiblock.
- Echocardiogram and Doppler revealed abnormalities in 38.8% of Chagasic patients, including ventricular relaxation issues and chamber enlargement.
- A significant number of Chagasic patients (44.29%) showed alterations in at least one test; echocardiogram and Doppler identified cardiac involvement in cases with normal ECGs.
Conclusions:
- Echocardiogram and Doppler are more sensitive than ECG for detecting cardiac involvement in asymptomatic Chagas disease.
- These imaging modalities should be integrated into routine diagnostic protocols for the indeterminate phase of Chagas disease.
- Early detection via echocardiogram and Doppler can improve management and outcomes for patients with Chagas disease.
Abstract:
A total of 70 blood-donor volunteers were studied to determine the utility of the echocardiogram and Doppler in the diagnosis of cardiopathies in asymptomatic patients with Chagas disease. These patients came from endemic areas and had humoral positive reactions for South American Trypanosomiasis. They were checked against a control group of blood-donors with no environmental antecedents and with negative reactions. Both groups were similar in age and sex. The chagasic group showed an abnormal electrocardiogram in twelve cases (17.4%), being left anterior hemiblock the most frequent alteration found (nine cases, 62.5%). In the control group no alterations were found (p = 0.0005). The echocardiogram and Doppler were abnormal in 29 cases of the chagasic group (38.8%): alterations in ventricular relaxation were found in 8 cases (27.6%), enlargement of cavities in 9 (31%), both phenomena in 9 (31%) and alteration of parietal motility in 3 (10.3%). In the control group, 1 case presented alteration in ventricular relaxation (p = 0.000008). These results confirmed that the abnormal discoveries were related to Chagas disease. Out of 70 chagasic patients, 31 (44.29%) showed some alteration in the tests: 12 had an abnormal electrocardiogram, and of these only 2 had normal echocardiogram and Doppler, the rest showed abnormal echocardiogram and Doppler. Other 29 (of these 70 patients) showed some alteration in the echocardiogram and Doppler, and 20 of them presented a normal electrocardiogram. It can be concluded that the echocardiogram and Doppler are more accurate to detect cardiac involvement in asymptomatic chagasic patients than the electrocardiogram, showing abnormality in many cases where there are no electrocardiographic alterations. On the other hand, patients with abnormal electrocardiogram and Doppler are less frequent. Therefore, to define the undetermined period of Chagas disease echocardiogram and Doppler should be incorporated as a routine resource of diagnosis considering the high percentage of cases in which cardiac participation is detected when there is no clinic, radiologic and electrocardiographic disturbance.