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Longitudinal Speckle Tracking Strain Abnormalities in Chagas Disease: A Systematic Review and Meta-Analysis
Sergio Alejandro Gómez-Ochoa1, Lyda Z Rojas2, Juliana Alexandra Hernández-Vargas3
1Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland.
Insights
Chronic Chagas cardiomyopathy (CCM) shows significant left ventricular longitudinal strain (LVLS) differences compared to the indeterminate form. Speckle tracking strain patterns reveal distinct myocardial function changes across Chagas disease stages.
Area of Science:
- Cardiology
- Medical Imaging
- Parasitic Diseases
Background:
- Chronic Chagas cardiomyopathy (CCM) is a leading cause of heart failure mortality.
- CCM involves unique left ventricular (LV) myocardial alterations.
- LV longitudinal speckle tracking strain is a key method for assessing LV function and cardiovascular risk.
Purpose of the Study:
- To characterize LV longitudinal strain patterns in different stages of Chagas disease (CD) using speckle tracking.
- To compare these patterns between patients with CCM, indeterminate form (IF), and healthy controls.
Main Methods:
- Systematic review and meta-analysis of studies published up to May 2021.
- Searched Medline, EMBASE, and LILACS databases.
- Included studies reporting LV strain measures in CD patients; pooled data using random-effects meta-analyses.
Main Results:
- Analyzed 10 studies with 1222 participants (477 CCM, 444 IF, 301 controls).
- CCM patients had significantly higher global longitudinal strain (GLS) than IF patients (SMD 1.253).
- IF patients showed worse segmental strain in basal-inferoseptal and mid-inferoseptal segments compared to controls.
Conclusions:
- Myocardial function shows distinct derangements across Chagas disease stages.
- LV longitudinal strain and speckle tracking measures may aid in predicting disease progression and clinical outcomes.
- Further research is needed to establish the prognostic role of these imaging techniques in CD.
Background:
Chronic Chagas cardiomyopathy (CCM) is ranked among heart failure etiologies with the highest mortality rates. CCM is characterized by alterations in left ventricular function with a typical and unique pattern of myocardial involvement. Left ventricle longitudinal speckle tracking strain is emerging as an important additive method for evaluating left ventricular function and risk of future cardiovascular events. This systematic review aimed to characterize the left ventricle (LV) longitudinal strain by speckle tracking patterns in the different stages of Chagas disease, compared to healthy controls.
Methods:
Searches in Medline, EMBASE, and LILACS databases (from inception to 20 May 2021) were performed. Articles written in any language that assessed patients with Chagas disease and reported any measures derived from the left ventricular strain by speckle tracking were included. Two reviewers independently selected the studies, extracted the data, and assessed the quality of evidence. Standardized mean differences (SMD) were pooled using random-effects meta-analyses.
Results:
Of 1044 references, ten studies, including a total of 1222 participants (CCM: 477; indeterminate form: 444; healthy controls: 301), fulfilled the selection criteria and were included in the final analysis. Patients with CCM had a significantly higher mean global longitudinal strain (GLS) value than indeterminate form (IF) patients (SMD 1.253; 95% CI 0.53, 1.98. I2 = 94%), while no significant difference was observed between IF patients and healthy controls (SMD 0.197; 95% CI -0.19, 0.59. I2 = 80%). Segmental strain analyses revealed that patients with the IF form of CD had significantly worse strain values in the basal-inferoseptal (SMD 0.49; 95% CI 0.24, 0.74. I2: 24%), and mid-inferoseptal (SMD 0.28; 95% CI 0.05, 0.50. I2: 10%) segments compared to healthy controls.
Conclusions:
Our results suggest different levels of functional derangements in myocardial function across different stages of Chagas disease. Further research is needed to assess the prognostic role of LV longitudinal strain and other measures derived from speckle tracking in CD patients regarding progression to cardiomyopathy and clinical outcomes prediction.
