title: Right Ventricular Systolic Dysfunction in Chagas Disease Defined by Speckle-Tracking Echocardiography: A Comparative Study with Cardiac Magnetic Resonance Imaging.
abstract: BACKGROUND
  Chagas disease leads to biventricular heart failure, usually with prominent systemic congestion. Although echocardiography is widely used in clinical routine, the utility of echocardiographic parameters to detect right ventricular (RV) systolic dysfunction in patients with Chagas disease is unknown. We sought to study the diagnostic value of echocardiography, including speckle-tracking parameters, to distinguish individuals with RV systolic dysfunction from those with normal RV systolic function in Chagas disease using cardiac magnetic resonance (CMR) as the reference method.
  
  
  METHODS
  In this cross-sectional study, 63 individuals with Chagas disease underwent echocardiography and CMR evaluations. Conventional echocardiographic parameters for RV functional evaluation were tricuspid annular plane systolic excursion, RV systolic excursion velocity, fractional area change, and RV index of myocardial performance. Strain and strain rate were obtained by two-dimensional speckle-tracking echocardiography and defined as "RV free wall," when based only in segments from RV free wall, or "RV free wall and septum," when segments from both free RV wall and interventricular septum were included. RV systolic dysfunction was defined as RV ejection fraction (RVEF) < 50% by CMR.
  
  
  RESULTS
  Mean age was 56 ± 14 years, and 58.7% of the patients were men. RV systolic dysfunction was detected by CMR in 18 (28.6%) individuals. RV free wall strain showed the highest correlation with RVEF by CMR (r = -0.62, P < .001), followed by fractional area change (r = 0.56, P < .001), RV free wall and septum strain (r = -0.54, P < .001), RV free wall and septum strain rate (r = -0.47, P < .001), RV free wall strain rate (r = -0.45, P < .001), and RV systolic excursion velocity (r = 0.30, P = .016). The RV index of myocardial performance and tricuspid annular plane systolic excursion showed a small and not significant correlation with RVEF (r = -0.20, P = .320; r = 0.14; P = .289, respectively). Using predefined cutoffs for RV systolic dysfunction, RV free wall strain (>-22.5% for men and >-23.3% for women) exhibited the highest area under the receiver operating characteristic curve (area under the curve = 0.829) to differentiate the presence from the absence of RV systolic dysfunction in Chagas disease, with a sensitivity and specificity of 67% and 83%, respectively.
  
  
  CONCLUSIONS
  RV free wall strain is an appropriate and superior echocardiographic variable for evaluating RV systolic function in Chagas disease, and it should be the method of choice for this purpose.
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Electronic address: htmoreira@hcrp.usp.br.
authors.forename: Henrique T
authors.initials: HT
authors.lastname: Moreira
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Volpe
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: José A
authors.initials: JA
authors.lastname: Marin-Neto
authors.affiliation: Department of Cardiovascular Imaging, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Chike C
authors.initials: CC
authors.lastname: Nwabuo
authors.affiliation: Department of Cardiovascular Imaging, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Bharath
authors.initials: B
authors.lastname: Ambale-Venkatesh
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Gali
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Oswaldo C
authors.initials: OC
authors.lastname: Almeida-Filho
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Minna M D
authors.initials: MMD
authors.lastname: Romano
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pazin-Filho
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Benedito C
authors.initials: BC
authors.lastname: Maciel
authors.affiliation: Department of Cardiovascular Imaging, Johns Hopkins University, Baltimore, Maryland.
authors.forename: João A C
authors.initials: JAC
authors.lastname: Lima
authors.affiliation: Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Schmidt
mesh_terms: D002598:Chagas Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: Chagas disease; Echocardiography; Right ventricular function; Speckle-tracking imaging