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Left ventricular global performance and diastolic function in indeterminate and cardiac forms of Chagas' disease
Antônio Pazin-Filho1, Minna M Dias Romano, Rogério Gomes Furtado
1Division of Cardiology, Department of Internal Medicine, University Hospital, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Insights
Patients with indeterminate Chagas' disease (IF) show no signs of heart problems. Echocardiography reveals no impairment in systolic or diastolic function in the indeterminate form, distinguishing it from the cardiac form of Chagas' disease.
Area of Science:
- Cardiology
- Infectious Diseases
- Echocardiography
Background:
- Chagas' disease often presents with an indeterminate form (IF) lasting decades, characterized by seropositivity but no clinical symptoms or echocardiographic abnormalities.
- Patients in the IF group typically exhibit normal electrocardiograms, heart size, and left ventricular systolic function on 2D echocardiography.
Purpose of the Study:
- To investigate potential impairments in left ventricular global performance (Tei index) and diastolic function in patients with the indeterminate form of Chagas' disease.
- To differentiate cardiac function between healthy controls, patients with IF, and those with the cardiac form of Chagas' disease.
Main Methods:
- Studied 43 individuals: 14 healthy volunteers, 12 patients with IF, and 17 with the cardiac form of Chagas' disease.
- Utilized 2D echocardiography to measure ejection fraction, Tei index, left atrial volume index, transmitral flow velocities, pulmonary vein flow velocities, and tissue Doppler velocities.
Main Results:
- Patients with the cardiac form showed significantly lower ejection fraction and S' velocity compared to controls and IF groups.
- The Tei index did not effectively differentiate between cardiac and non-cardiac forms of Chagas' disease.
- Diastolic dysfunction was evident in the cardiac form group, indicated by elevated left atrial volume index and altered transmitral/pulmonary vein flow patterns, but not in the IF group.
Conclusions:
- Patients with the indeterminate form of Chagas' disease exhibit no detectable abnormalities in systolic or diastolic cardiac function.
- Echocardiographic assessment, specifically the absence of regional systolic dysfunction markers, confirms preserved cardiac function in the IF stage.
- These findings underscore the importance of detailed echocardiographic evaluation for characterizing cardiac status in Chagas' disease patients.
Abstract:
The majority of patients with Chagas' disease remain for 10 to 30 years in the indeterminate form (IF) of this disease. They have no symptoms, serologic positivity, normal electrocardiogram results and heart size, and normal left ventricular global and segmental systolic function on 2-dimensional echocardiography. To investigate whether this group of patients have any impairment of left ventricular global performance (Tei index) and diastolic function, we have studied 43 individuals (age 49 +/- 12 years) including 14 healthy volunteers and 29 patients with Chagas' disease divided as IF (n = 12) and cardiac form (n = 17). Echocardiographic measurements included ejection fraction, Tei index, left atrial volume index, transmitral (peak early transmitral flow velocity, late peak mitral velocity, tissue Doppler, late peak mitral velocity duration) and pulmonary (systolic pulmonary vein velocity, diastolic pulmonary vein velocity, retrograde pulmonary vein velocity, retrograde pulmonary vein velocity duration) flow velocities, and tissue Doppler velocities at lateral mitral annulus (peak early transmitral flow velocity, late peak mitral velocity, systolic pulmonary vein velocity). Although ejection fraction and S' velocity were significantly lower for patients with cardiac form compared with control and IF groups, Tei index was not able to differentiate patients with cardiac conditions from the other groups. Diastolic dysfunction was documented for patients with cardiac form by left atrial volume index, early transmitral peak velocity, early expansion wave by tissue Doppler, late expansion wave by tissue Doppler, and peak early transmitral flow velocity/early expansion wave by tissue Doppler. Patients with the IF of Chagas' disease did not show any abnormality of diastolic function. Thus, when the IF is further characterized on the basis of absence of any echocardiographic marker of regional systolic dysfunction, no impairment of diastolic function can be detected.
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