title: Comprehensive left ventricular mechanics analysis by speckle tracking echocardiography in Chagas disease.
abstract: BACKGROUND
  Chagas disease (CD) is a frequent cause of dilated cardiomyopathy (CMP) in developing countries, leading to clinical heart failure and worse prognosis. Therefore, the development and evolution of this CMP has always been a major topic in numbers of previous studies. A comprehensive echocardiographic study of left ventricular (LV) mechanics, fully assessing myocardial contraction, has never been done before. This could help characterize and improve the understanding of the evolution of this prevalent CMP.
  
  
  METHODS
  A total of 47 chagasic and 84 control patients were included in this study and allocated in groups according to LV ejection fraction. 2D-Echocardiogram was acquired for LV mechanics analysis by speckle tracking echocardiography.
  
  
  RESULTS
  Mean age of chagasic individuals was 55y and 16 (34 %) were men. Significant difference was found in global longitudinal velocity analysis, with lower values in indeterminate form. In the group with severe systolic dysfunction, a paradoxical increase in longitudinal and apical radial displacements were demonstrated. In parallel, segmental analyzes highlighted lower values of radial displacement, strain and strain rate into inferior and inferolateral walls, with increase of these values in septal and anterior walls.
  
  
  CONCLUSIONS
  Chagasic CMP has a vicarious pattern of contraction in the course of its evolution, defined by reduced displacement and strain into inferior and posterior walls with paradoxical increase in septal and anterior segments. Also, lower longitudinal velocities were demonstrated in CD indeterminate form, which may indicate an incipient myocardial injury.
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil. marcio.lima@incor.usp.br.
authors.forename: Marcio Silva Miguel
authors.initials: MS
authors.lastname: Lima
authors.affiliation: Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
authors.forename: Hector R
authors.initials: HR
authors.lastname: Villarraga
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Maria Cristina Donadio
authors.initials: MC
authors.lastname: Abduch
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Marta Fernandes
authors.initials: MF
authors.lastname: Lima
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Cecilia Beatriz Bittencourt Viana
authors.initials: CB
authors.lastname: Cruz
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Marcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Mariana Callil
authors.initials: MC
authors.lastname: Voos
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Joao Cesar Nunes
authors.initials: JC
authors.lastname: Sbano
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
authors.affiliation: Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
authors.forename: Jeane Mike
authors.initials: JM
authors.lastname: Tsutsui
mesh_terms: D000328:Adult; D002598:Chagas Cardiomyopathy / Q000175:diagnosis / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Cardiac mechanics; Cardiomyopathies; Speckle tracking echocardiography; Strain