Three and Two-Dimensional Cardiac Mechanic Parameters by Speckle Tracking Echocardiography are Predictors of Outcomes In Chagas Heart Disease

BACKGROUND: Chagas disease (CD) is a neglected infectious disease associated with early mortality and substantial disability. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We aim to characterize new echocardiographic variables in patients with CD and to assess the hypothesis that 3D STE may predict outcomes. METHODS: Seventy-two patients with CD were included. Clinical and conventional 2D and 3D STE analysis were performed. Patients were followed up for sixty months. Clinical events were defined as hospitalization for heart failure, complex ventricular arrhythmias, heart transplant and all-cause death. RESULTS: Seventy-two patients were recruited and enrolled in three groups: left ventricular ejection fraction (LVEF) < 0.40 (N=22); 0.40 < LVEF < 0.50 (N=10) and LVEF > 0.50 (N=30). After a Cox model analysis, the top predictors of composite endpoints were 2D LV global longitudinal strain (GLS) ≤ -11.3% (AUC=0.87), 2D LV global circumferential strain (GCS) ≤ -10.1% (AUC=0.79), 3D LV GLS≤ -13% (AUC=0.82), 3D LV area strain ≤ -16% (AUC=0.81) and right ventricle (RV) GLS ≤ -17.2% (AUC=0.78). CONCLUSIONS: Patients with CD and mrLVEF were morphologically similar to the rLVEF patients despite the benign evolution as the pLVEF group. RV GLS, 2D LV GLS, 2D LV GCS, 3D LV GLS, and 3D LV area strain are strong predictors of sixty months outcomes in patients with CD.

Clinical and Echocardiographic Characteristics After Six Months of Sacubitril Valsartan in Chagas Heart Disease.

Chagas cardiomyopathy is the most prevalent non-ischemic cardiomyopathy in Latin America, with high morbidity and mortality even today. Treatment of these patients is based on the use of medications for heart failure. This study evaluated a cohort of patients with Chagas heart disease who used sacubitril valsartan at a referral hospital for the disease in Brazil. After six months, there was a symptomatic improvement in these individuals assessed by the NYHA classification, with a 44.3% reduction in the absolute number of patients classified as III-IV in the period (p 0.035), but without changes in the parameters on the echocardiogram for reverse ventricular remodeling and still high mortality rate and hospitalization. These results emphasize the importance of studying the use of sacubitril valsartan in chagas heart disease to better describe its effectiveness taking into account the peculiarities of these individuals.