Early Detection of Left Ventricular Diastolic Dysfunction
Early Detection of Left Ventricular Diastolic Dysfunction
Background: Chagas' disease may cause left ventricular diastolic dysfunction and its early detection in asymptomatic patients would allow to stratify the risk and to optimize medical treatment. The aim of this study is to investigate if transmitral Doppler flow can detect early abnormalities of the diastolic left ventricular function in patients during the indeterminate phase of Chagas' disease, in which the electrocardiogram (ECG), chest x-ray and 2-D echocardiogram (2D-echo) are normal.
Methods: a group of 54 patients with Chagas' disease was studied and compared to a control group of 27 subjects of similar age. All were assessed with an ECG, chest X-ray, 2-D echo, and transmitral Doppler flow.
Results: both groups had similar values in the 2D-echo. In patients with Chagas' disease, the transmitral Doppler showed a higher peak A velocity (control group: 0.44 m/sec, Chagas group: 0.55 m/sec, p = 0.001), a lower E/A ratio (control group: 1.45, Chagas group: 1.22, p < 0.05), and a lengthening of the deceleration time of early diastolic filling (control: 138.7 ± 26.8 msec, Chagas group: 167.9 ± 34.6 msec, p = 001), thus revealing an early disorder of the diastolic left ventricular function in patients with Chagas' disease.
Conclusion: in patients with Chagas' disease who are in the indeterminate phase, transmitral Doppler flow allowed to identify early abnormalities of the left ventricular diastolic function, which provide useful clinical information for prognostic stratification and treatment.
Chagas' disease is a protozoan infestation caused by Trypanosoma cruzi and is one of the most relevant public health problems and a major cause of heart failure and death in Latin America. More than 100 million people are estimated to be infected and at risk of acquiring the disease and more than 18 million have already acquired it, and it causes 50.000 deaths per year, especially among the poorer countries. As a consequence of migrations from Latin America, a globalization of the disease is under way, and there currently are thousands of infected Latin Americans residing in the US and Europe. In Argentina, 20% of the 2 million infected people develop Chagas' disease, which causes 5.000 6.000 deaths per year.
Most infested patients are in the indeterminate phase of the disease, defined as the phase without ECG, X-ray or 2D-echo abnormalities and without signs of clinical cardiac involvement; One third of these patients will eventually develop chronic Chagas cardiomyopathy. During this indeterminate stage, the early detection of myocardial damage may be important for an individual approach to risk stratification. Among the available methods, transmitral Doppler flow may be very useful for the quantitative analysis of the left ventricular diastolic function.
The objective of this study was to assess the usefulness of transmitral Doppler flow to detect early left ventricular diastolic function abnormalities in patients during the indeterminate stage of Chagas' disease, when the ECG, chest X-ray and 2- echo are normal.
Abstract and Background
Abstract
Background: Chagas' disease may cause left ventricular diastolic dysfunction and its early detection in asymptomatic patients would allow to stratify the risk and to optimize medical treatment. The aim of this study is to investigate if transmitral Doppler flow can detect early abnormalities of the diastolic left ventricular function in patients during the indeterminate phase of Chagas' disease, in which the electrocardiogram (ECG), chest x-ray and 2-D echocardiogram (2D-echo) are normal.
Methods: a group of 54 patients with Chagas' disease was studied and compared to a control group of 27 subjects of similar age. All were assessed with an ECG, chest X-ray, 2-D echo, and transmitral Doppler flow.
Results: both groups had similar values in the 2D-echo. In patients with Chagas' disease, the transmitral Doppler showed a higher peak A velocity (control group: 0.44 m/sec, Chagas group: 0.55 m/sec, p = 0.001), a lower E/A ratio (control group: 1.45, Chagas group: 1.22, p < 0.05), and a lengthening of the deceleration time of early diastolic filling (control: 138.7 ± 26.8 msec, Chagas group: 167.9 ± 34.6 msec, p = 001), thus revealing an early disorder of the diastolic left ventricular function in patients with Chagas' disease.
Conclusion: in patients with Chagas' disease who are in the indeterminate phase, transmitral Doppler flow allowed to identify early abnormalities of the left ventricular diastolic function, which provide useful clinical information for prognostic stratification and treatment.
Background
Chagas' disease is a protozoan infestation caused by Trypanosoma cruzi and is one of the most relevant public health problems and a major cause of heart failure and death in Latin America. More than 100 million people are estimated to be infected and at risk of acquiring the disease and more than 18 million have already acquired it, and it causes 50.000 deaths per year, especially among the poorer countries. As a consequence of migrations from Latin America, a globalization of the disease is under way, and there currently are thousands of infected Latin Americans residing in the US and Europe. In Argentina, 20% of the 2 million infected people develop Chagas' disease, which causes 5.000 6.000 deaths per year.
Most infested patients are in the indeterminate phase of the disease, defined as the phase without ECG, X-ray or 2D-echo abnormalities and without signs of clinical cardiac involvement; One third of these patients will eventually develop chronic Chagas cardiomyopathy. During this indeterminate stage, the early detection of myocardial damage may be important for an individual approach to risk stratification. Among the available methods, transmitral Doppler flow may be very useful for the quantitative analysis of the left ventricular diastolic function.
The objective of this study was to assess the usefulness of transmitral Doppler flow to detect early left ventricular diastolic function abnormalities in patients during the indeterminate stage of Chagas' disease, when the ECG, chest X-ray and 2- echo are normal.