Left atrial and left ventricular diastolic function in chronic Chagas disease.
BACKGROUND
Left atrial (LA) and left ventricular (LV) diastolic function analysis can yield new strategies to recognize early cardiac involvement and prognostic indicators in Chagas disease.


METHODS
Patients with Chagas disease with the indeterminate (n = 69) or with the cardiac form (32 with changes limited to electrocardiography [stage A], 25 with changes in LV systolic function but no heart failure [HF; stage B], and 26 with HF) underwent evaluation of LV diastolic function (mitral inflow, pulmonary vein flow, color M-mode echocardiography, and tissue Doppler analysis), and LA function by three-dimensional echocardiography and strain analysis and were prospectively followed for the occurrence of clinical events. Echocardiograms were also obtained from 32 controls.


RESULTS
LV diastolic dysfunction was gradually more prevalent and severe across groups from patients with the indeterminate form of Chagas disease to patients with HF. Tissue Doppler was the best tool to demonstrate the worsening of LV diastolic function across the groups (E' velocity: controls, 12.6 ± 2.3 cm/sec; patients with the indeterminate form, 12.1 ± 3.1 cm/sec; stage A, 10.3 ± 2.9 cm/sec; stage B, 8.3 ± 2.8 cm/sec; patients with HF, 5.6 ± 1.9; P < .0001). Although maximum LA volume was increased only in patients with HF, minimum LA volume (controls, 8 ± 2 mL/m(2); patients with the indeterminate form, 8 ± 2 mL/m(2); stage A, 9 ± 3 mL/m(2); stage B, 11 ± 4 mL/m(2); patients with HF, 27 ± 17 mL/m(2); P < .0001) and precontraction LA volume (controls, 11 ± 3 mL/m(2); patients with the indeterminate form, 12 ± 3 mL/m(2); stage A, 13 ± 4 mL/m(2); stage B, 16 ± 5 mL/m(2); patients with HF, 32 ± 19 mL/m(2); P < .0001) were increased in all cardiac form groups. LA conductive function was depressed in all cardiac form groups, while LA contractile function was depressed only in patients with HF. Cox proportional-hazards regression analysis revealed that end-systolic LV diameter (hazard ratio, 1.6; 95% confidence interval, 0.9-2.8; P = .09), E' velocity (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8; P = .001), and peak negative global LA strain (hazard ratio, 1.21; 95% confidence interval, 1.02-1.4; P = .03), were independent predictors of clinical events.


CONCLUSIONS
LV diastolic dysfunction was found in all forms of chronic Chagas disease, including those without LV systolic dysfunction. LV diastolic dysfunction may contribute to changes in LA volume and conductive function found in early stages of the cardiac form. Both LV diastolic function and LA contractile function were independent predictors of clinical events.
Instituto Nacional de Cardiologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Cesar Augusto S
CA
Nascimento
Victor Augusto M
VA
Gomes
Sabrina K
SK
Silva
Carla Renata F
CR
Santos
Mayara C
MC
Chambela
Fabiana S
FS
Madeira
Marcelo T
MT
Holanda
Pedro Emmanuel A A
PE
Brasil
Andrea S
AS
Sousa
Sergio S
SS
Xavier
Alejandro M
AM
Hasslocher-Moreno
Ademir B
AB
Cunha
Roberto M
RM
Saraiva
D016279:Atrial Function, Left; D002598:Chagas Cardiomyopathy / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left
2D; CI; Chagas disease; Confidence interval; ELISA; Enzyme-linked immunosorbent assay; HF; Heart failure; LA; LV; Left atrial; Left atrial function; Left ventricular; Left ventricular diastolic function; RT3DE; RV; Real-time three-dimensional echocardiography; Right ventricular; STE; Speckle-tracking echocardiography; Strain; Two-dimensional; Two-dimensional strain; VTI; Velocity-time integral; ε