Myocardial function reclassification: Echocardiographic strain patterns in patients with chronic Chagas cardiomyopathy and intraventricular dyssynchrony

• Published in: International journal of cardiology Vol. 348; pp. 102 - 107
• Main Authors: Athayde, Guilherme A.T., Borges, Bruno C.C., Pinheiro, Andreia O., Souza, Aline L., Oliveira, Camila P., Martins, Sergio A.M., Teixeira, Ricardo A., Siqueira, Sergio F., Porter, Thomas Richard, Mathias Junior, Wilson, Martinelli Filho, Martino
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2022
• Subjects: Chagas cardiomyopathy; Chagas Cardiomyopathy - diagnostic imaging; Cross-Sectional Studies; Echocardiography; Humans; Intraventricular dyssynchrony; Stress echocardiography; Stroke Volume; Ventricular dysfunction; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - epidemiology; Ventricular Function, Left; Stress echocardiography; Ventricular dysfunction; Intraventricular dyssynchrony; Chagas cardiomyopathy
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.12.005

We aimed to identify, among Chronic Chagas Cardiomyopathy (CCC) patients with left ventricular dysfunction (LVD) and non-left bundle branch block (non-LBBB), subgroups with different functional and mechanical patterns of global longitudinal strain (GLS) and intraventricular dyssynchrony (IVD) at rest and after exercise stress test, and reclassify them using a new echocardiographic approach. In this single-center cross-sectional study, 40 patients with CCC, left ventricular ejection fraction (LVEF) ≤ 35% and non-LBBB underwent rest echocardiography and then treadmill exercise stress echocardiography with GLS and IVD analysis. The sample was divided into four groups, based on GLS and IVD significant variation between rest and exercise: GLS + IVD+ (9 patients); GLS + IVD- (9 patients); GLS-IVD+ (10 patients); GLS-IVD- (10 patients). At rest, median LVEF was 28% (21.3%–33%) and GLS (−7% (−5%/−9.3%), were not different among groups. The average response of GLS was an increase of 0.74% over rest values, and the average response of IVD was a decrease of 6.9 ms. Group GLS-IVD+ presented more dyssynchrony at rest (p = 0.01). Left atrial (LA) volume (higher in GLS-IVD-) (p = 0.022) and TAPSE (higher in GLS + IVD+) (p = 0.015) were also different among groups at baseline. Of the 40 patients evaluated, 27 (67.5%) had very severe LVD (GLS < −8%). In addition, among these patients, 11 patients had contractile reserve after undergoing stress echocardiography. In patients with CCC, severe LVD and non-LBBB, the evaluation of GLS and IVD between rest and exercise was able to reclassify myocardial function and to identify subgroups with contractile reserve and significant dyssynchronopathy. •Myocardial mechanics behavior at exercise differentiate four groups of Chagas cardiomyopathy patients•Evaluation of IVD on exercise refines findings of baseline ventricular dyssynchrony•Evaluation of GLS (rest and exercise) can reclassify myocardial function identifying subgroups with contractile reserve•Even among patients with severe left ventricular dysfunction, there was a subgroup with contractile reserve