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Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease
Amanda Arantes Perez1, Antonio Luiz Pinho Ribeiro, Márcio Vinícius Lins Barros
1Hospital das Clínicas da Faculdade de Medicina da UFMG e Ecoar - Medicina Diagnóstica. Belo Horizonte, Brasil.
Insights
Chest X-rays are not reliable for diagnosing left ventricular dysfunction in Chagas' disease patients. Further evaluation of chest radiography as an initial screening tool is recommended.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- Chagas' disease, caused by *Trypanosoma cruzi*, frequently leads to cardiac complications, including left ventricular dysfunction.
- Early diagnosis of left ventricular dilation and systolic dysfunction is crucial for managing Chagas' cardiomyopathy.
- The role of conventional chest radiography in assessing cardiac function in these patients remains debated.
Purpose of the Study:
- To evaluate the diagnostic accuracy of chest radiography for detecting left ventricular dilation and systolic dysfunction in Chagas' disease.
- To determine the utility of the cardiothoracic ratio as a marker for left ventricular dysfunction in this population.
Main Methods:
- A cross-sectional study included 166 consecutive patients with Chagas' disease.
- Cardiac assessment involved chest radiography and Doppler echocardiography.
- Sensitivity, specificity, predictive values, and ROC curve analysis were used to assess chest radiography's accuracy; cardiothoracic ratio was correlated with ejection fraction and diastolic diameter.
Main Results:
- Chest radiography demonstrated a sensitivity of 50% and specificity of 80.5% for diagnosing left ventricular dysfunction.
- Positive and negative predictive values were 51.2% and 79.8%, respectively.
- The cardiothoracic ratio showed weak correlations with left ventricular ejection fraction (r=-0.23) and diastolic diameter (r=0.30); ROC curve area was 0.734.
Conclusions:
- Thoracic radiological studies are not sufficiently accurate to diagnose left ventricular dysfunction in Chagas' disease.
- The clinical utility of chest radiography as an initial screening tool for patients with Chagas' disease requires reevaluation.
- Further research may be needed to identify more reliable non-invasive methods for early detection of cardiac involvement.
Objective:
To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease.
Methods:
A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter.
Results:
The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23) and left ventricular diastolic diameter (r=0.30). The area calculated under the ROC curve was 0.734.
Conclusion:
The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.