Left atrial and left ventricular diastolic function in chronic Chagas disease.

BACKGROUND: Left atrial (LA) and left ventricular (LV) diastolic function analysis can yield new strategies to recognize early cardiac involvement and prognostic indicators in Chagas disease. METHODS: Patients with Chagas disease with the indeterminate (n = 69) or with the cardiac form (32 with changes limited to electrocardiography [stage A], 25 with changes in LV systolic function but no heart failure [HF; stage B], and 26 with HF) underwent evaluation of LV diastolic function (mitral inflow, pulmonary vein flow, color M-mode echocardiography, and tissue Doppler analysis), and LA function by three-dimensional echocardiography and strain analysis and were prospectively followed for the occurrence of clinical events. Echocardiograms were also obtained from 32 controls. RESULTS: LV diastolic dysfunction was gradually more prevalent and severe across groups from patients with the indeterminate form of Chagas disease to patients with HF. Tissue Doppler was the best tool to demonstrate the worsening of LV diastolic function across the groups (E' velocity: controls, 12.6 ± 2.3 cm/sec; patients with the indeterminate form, 12.1 ± 3.1 cm/sec; stage A, 10.3 ± 2.9 cm/sec; stage B, 8.3 ± 2.8 cm/sec; patients with HF, 5.6 ± 1.9; P < .0001). Although maximum LA volume was increased only in patients with HF, minimum LA volume (controls, 8 ± 2 mL/m(2); patients with the indeterminate form, 8 ± 2 mL/m(2); stage A, 9 ± 3 mL/m(2); stage B, 11 ± 4 mL/m(2); patients with HF, 27 ± 17 mL/m(2); P < .0001) and precontraction LA volume (controls, 11 ± 3 mL/m(2); patients with the indeterminate form, 12 ± 3 mL/m(2); stage A, 13 ± 4 mL/m(2); stage B, 16 ± 5 mL/m(2); patients with HF, 32 ± 19 mL/m(2); P < .0001) were increased in all cardiac form groups. LA conductive function was depressed in all cardiac form groups, while LA contractile function was depressed only in patients with HF. Cox proportional-hazards regression analysis revealed that end-systolic LV diameter (hazard ratio, 1.6; 95% confidence interval, 0.9-2.8; P = .09), E' velocity (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8; P = .001), and peak negative global LA strain (hazard ratio, 1.21; 95% confidence interval, 1.02-1.4; P = .03), were independent predictors of clinical events. CONCLUSIONS: LV diastolic dysfunction was found in all forms of chronic Chagas disease, including those without LV systolic dysfunction. LV diastolic dysfunction may contribute to changes in LA volume and conductive function found in early stages of the cardiac form. Both LV diastolic function and LA contractile function were independent predictors of clinical events.

Diferentes significados da disfunção diastólica tipo I, conforme o grupo estudado - nova proposta de classificação da disfunção diastólica tipo I com Doppler ecocardiograma aliado ao Doppler tecidual / Diastolic dysfunction grade I associated with different implications according to the studied group - new proposal for diastolic dysfunction grade I classification using Doppler echocardiography and tissue Doppler imaging

Atualmente dispõe-se do Doppler pulsado e do Doppler tecidual paraclassificar a disfunção diastólica em quatro graus.Ainda assim, considera-se não ser adequado atribuir um mesmo grau dedisfunção diastólica a indivíduos tão distintos como normaise pacientes hipertensos, isquêmicos e outros. Neste trabalho, o objetivo édemonstrar que pacientes com patologias distintas e ummesmo grau de disfunção diastólica podem ter característicasecocardiográficas bastante distintas.Foram estudados 86 indivíduos, sendo 25 atletas profissionais, 27adultos normais, 17 hipertensos e 17 coronariopatas, pelo ecocardiograma Doppler e Doppler tecidual. Foram determinadas as funçõessistólica, diastólica, diâmetros cavitários e massa do VE.Os atletas não apresentavam disfunção diastólica. Entre indivíduos com disfunção diastólica grau I, hipertensos ecoronariopatas, apresentavam espessuras parietais, massa do VE e diâmetro do AE maiores (P