Assessment of speckle tracking strain predictive value for myocardial fibrosis in subjects with Chagas disease

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2016-05-12T12:36:51Z No. of bitstreams: 1 Macedo CT Assessment....pdf: 661652 bytes, checksum: a14aaf455b6a4c89eef253f8b95079bc (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2016-05-12T12:51:06Z (GMT) No. of bitstreams: 1 Macedo CT Assessment....pdf: 661652 bytes, checksum: a14aaf455b6a4c89eef253f8b95079bc (MD5)Made available in DSpace on 2016-05-12T12:51:06Z (GMT). No. of bitstreams: 1 Macedo CT Assessment....pdf: 661652 bytes, checksum: a14aaf455b6a4c89eef253f8b95079bc (MD5) Previous issue date: 2015Hospital São Rafael. Departamento de Cardiologia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, BrasilHospital São Rafael. Departamento de Cardiologia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilBackground: One of the most challenging issues of chronic Chagas disease is to provide earlier detection of heart involvement. Two-dimensional speckle tracking (2-D ST) echocardiography, a new imagingmodalitywith useful applications in several cardiac diseases, has been validated for subjects with myocardial infarction against cardiac magnetic resonance (CMR). Here we hypothesize that the longitudinal global strain (LGS) has an incremental value to ejection fraction for predicting myocardial fibrosis in subjects with Chagas disease. Methods: This observational study comprised 58 subjectswith Chagas disease, confirmed by two positive serologic tests. All subjects underwent conventional Doppler echocardiogramplus speckle tracking strain, and cardiacmagnetic resonance. Results: The ROC curve analysis revealed that both LGS (area under the curve: 0.78, p=0.001) and ejection fraction (area under the curve: 0.82, p b 0.001)were significant predictors ofmyocardial fibrosis. Regarding the percentage of fibrosis, a high correlation was observed with both ejection fraction assessed by echocardiography (r =0.70, p b 0.001) and LGS (r = 0.64, p b 0.001). However, when adjusted through multiple linear regression, the LGS lost statistical significance as a predictor of myocardial fibrosis (p = 0.111). Conclusions: LGS has no incremental value to conventional ejection fractionmeasurement in the prediction ofmyocardial fibrosis in subjects with Chagas disease

Lack of association between serum syndecan-4, myocardial fibrosis and ventricular dysfunction in subjects with chronic Chagas disease

<div><p>Background</p><p>Syndecan-4 is a transmembrane glycoprotein associated with inflammation and fibrosis. Increased syndecan-4 levels were previously detected after acute myocardial infarction and in subjects with heart failure. However, the levels of syndecan-4 in subjects with Chagas disease have not so far been investigated. The aim of this study was to investigate the potential role of serum sydencan-4 as a novel biomarker for myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease.</p><p>Methods</p><p>This study comprised subjects with Chagas disease (n = 56), being 14 (25%) with the indeterminate form, 16 (29%) with the cardiac form without ventricular dysfunction, and 26 (46%) with the cardiac form with ventricular dysfunction.</p><p>Results</p><p>Syndecan-4 serum concentrations did not correlate with presence or absence of myocardial fibrosis (P = 0.386) nor disease severity in subjects with Chagas disease (P = 0.918). Additionally, no correlation was found either between the degree of myocardial fibrosis and serum syndecan-4 [r = 0.08; P = 0.567] or between left ventricular ejection fraction and syndecan-4 [r = 0.02; P = 0.864]. In contrast, NT-proBNP levels correlated with ejection fraction and myocardial fibrosis.</p><p>Conclusions</p><p>Our results demonstrate the lack of correlations between serum syndecan-4, myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease. Further studies are required to show if syndecan-4 concentrations can be marker for prognosis assessment or disease progression.</p></div

Echocardiographic and CMR findings in subjects with Chagas disease.

<p>Echocardiographic and CMR findings in subjects with Chagas disease.</p

Correlation between percentage of myocardial fibrosis assessed by cardiovascular MRI and concentration of syndecan-4 and NT-ProBNP.

<p>A: Pearson’s correlation, r = 0.08, P = 0.567. B: Pearson’s correlation, r = 0.469, P<0.001.</p

Clinical and demographic characteristics of subjects with Chagas disease.

<p>Clinical and demographic characteristics of subjects with Chagas disease.</p

Serum concentration of syndecan-4 assessed by ELISA in subjects with and without delayed enhancement detected by magnetic resonance imaging.

<p>Circle = outlier, * = extreme outlier, <i>t</i> test, P = 0.386.</p

Correlation between LVEF and serum concentration of syndecan-4 and NT-ProBNP.

<p>A: Pearson’s correlation, LVEF assessed by Simpson’s method, r = 0.02, P = 0.864. B = Pearson’s correlation, LVEF assessed by Simpson’s method, r = 0.687, P<0.001.</p

Echocardiographic data in subjects with heart failure.

<p>Echocardiographic data in subjects with heart failure.</p

Serum concentration of syndecan-4 assessed by ELISA in subjects with different forms of Chagas disease.

<p>ANOVA, P = 0.918. Circle = outlier, * = extreme outlier, P = 0.395.</p