Incidence and variables associated with arrhythmias during dobutamine-atropine stress echocardiography among patients with Chagas disease.

BACKGROUND: Dobutamine stress echocardiography (DSE) is an important tool in the diagnosis of coronary artery disease. However, there is hesitation in clinical practice for using it in patients with Chagas disease (CD) due to the arrhythmogenic potential of this heart condition. This study aimed to evaluate the incidence and variables associated with arrhythmias during DSE in a population of patients with CD. METHODS: A population of 205 consecutive patients with CD and suspected coronary heart disease was assessed through a retrospective database analysis. CD was confirmed in all patients by serological testing. RESULTS: The mean age of the patients selected was 64 years, and 65.4% of the patients were female. Significant arrhythmias occurred as follows: nonsustained ventricular tachycardia in 7.3% of patients; supraventricular tachycardia and sustained ventricular tachycardia in 1%; and atrial fibrillation in 0.5%. Nonsignificant arrhythmias occurred as follows: premature ventricular contractions in 48% of patients and bigeminy in 4.4%. Values for the wall-motion score index at rest greater than 1.12 and 1.18 were independently correlated with the occurrence of nonsignificant arrhythmias (odds ratio [OR] = 2.90, P < 0.001) and significant arrhythmias (OR = 4.23, P = 0.044), respectively. CONCLUSION: DSE should be considered a safe examination in patients with CD despite the known increased risk of arrhythmias in this group of patients. The occurrence of arrhythmias was low in this study. Abnormal wall-motion score index values at rest were associated with the occurrence of significant and nonsignificant arrhythmias during the test.

Thoracic aorta evaluation in patients with Takayasu's arteritis by transesophageal echocardiography.

BACKGROUND: There is no detailed description of thoracic aorta abnormalities assessed by transesophageal echocardiography (TEE) in patients with Takayasu's arteritis (TA). We aimed to evaluate these features in a series of patients in the chronic stage of TA. METHODS: Fourteen patients (13 women, mean age 30 years) with inactive chronic TA were studied by TEE, and compared with 14 matched patients without aortic disease defined by TEE, who served as control subjects. In each segment of the thoracic aorta (ascending, arch, proximal, and distal descending aorta), we analyzed: (1) wall thickness; (2) diastolic diameters; and (3) systolic expansion index as a percentage of aortic expansibility. RESULTS: Increased circumferential wall thickness (71% of 55 aortic segments studied) and dilated segments (37%) were observed in patients with TA, with significant higher values than control subjects (P < .05). A global impairment of the elastic properties of the thoracic aorta of patients with TA was noted in 85% of the analyzed segments, expressed by a significant reduction of the systolic expansion index (3.9 +/- 3.8%) as compared with control subjects (14 +/- 5.7%; P < .005). CONCLUSIONS: TA as assessed by TEE is characterized by a remodeling process of the thoracic aorta with a marked and global decrease of aortic distensibility and concentric wall thickening. These features may be useful for noninvasive diagnosis of the chronic stage of TA by TEE.