title: Analysis of Regional Left Ventricular Strain in Patients with Chagas Disease and Normal Left Ventricular Systolic Function.
abstract: Chagas heart disease has a high socioeconomic burden, and any strategy to detect early myocardial damage is welcome. Speckle-tracking echocardiography assesses global and segmental left ventricular (LV) systolic function, yielding values of two-dimensional strain (ε). The aim of this study was to determine if patients with chronic Chagas disease and normal LV ejection fractions present abnormalities in global and segmental LV ε.
  
  
  
  In this prospective study, patients with Chagas disease with no evidence of cardiac involvement (group I; n = 83) or at stage A of the cardiac form (i.e., with changes limited to the electrocardiogram) (group A; n = 42) and 43 control subjects (group C) underwent evaluation of global and segmental LV ε by speckle-tracking echocardiography. A subset of randomly selected patients in group A underwent cardiac magnetic resonance imaging and repeated echocardiography 3.5 ± 0.8 years after the first evaluation.
  
  
  
  Mean age, chamber dimensions, and LV ejection fraction were similar among the groups. Global longitudinal (group C, -19 ± 2%; group I, -19 ± 2%; group A, -19 ± 2%), circumferential (group C, -19 ± 3%; group I, -20 ± 3%; group A, -19 ± 3%), and radial (group C, 46 ± 10%; group I, 45 ± 13%; group A, 42 ± 14%) LV ε were similar among the groups. Segmental longitudinal, circumferential, and radial LV ε were similar across the studied groups. Seven of 14 patients had areas of fibrosis on cardiac magnetic resonance imaging. Patients with fibrosis had lower global longitudinal (-15 ± 2% vs -18 ± 2%, P = .004), circumferential (-14 ± 2% vs -19 ± 2%, P = .002), and radial LV ε (36 ± 13% vs 54 ± 12%, P = .02) than those without cardiac fibrosis despite similar LV ejection fractions. Patients with fibrosis had lower radial LV ε in the basal inferoseptal wall than patients without cardiac fibrosis (27 ± 17% vs 60 ± 15%, P = .04).
  
  
  
  Patients with chronic Chagas disease and normal global and segmental LV systolic function on two-dimensional echocardiography had global and segmental LV ε similar to that of control subjects. However, those in the early stages of the cardiac form and cardiac fibrosis had lower global longitudinal, circumferential, and radial LV ε.
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
authors.forename: Victor Augusto M
authors.initials: VA
authors.lastname: Gomes
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Gabriel F
authors.initials: GF
authors.lastname: Alves
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil; Centro Estadual de Diagnóstico por Imagem, Secretaria de Estado de Saúde do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Hadlich
authors.affiliation: Centro Estadual de Diagnóstico por Imagem, Secretaria de Estado de Saúde do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Clerio F
authors.initials: CF
authors.lastname: Azevedo
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Iane M
authors.initials: IM
authors.lastname: Pereira
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Carla Renata F
authors.initials: CR
authors.lastname: Santos
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Pedro Emmanuel A A
authors.initials: PE
authors.lastname: Brasil
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Luiz Henrique C
authors.initials: LH
authors.lastname: Sangenis
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
authors.forename: Ademir B
authors.initials: AB
authors.lastname: Cunha
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Sergio S
authors.initials: SS
authors.lastname: Xavier
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. Electronic address: roberto.saraiva@ini.fiocruz.br.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Saraiva
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: Chagas disease; Left ventricular systolic function; Two-dimensional strain