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Association between ventricular arrhythmogenicity and myocardial mechanical dispersion assessed by strain echocardiography in chagas cardiomyopathy.
Introduction: Endemic Chaga's disease is a major health concern in Latin America. Ventricular arrhythmias (VA) is a hallmark of Chagas cardiomyopathy (ChD) associated with worse prognosis. Myocardial mechanical dispersion (MD) by speckle tracking echocardiography reflects heterogenous ventricular contractions and is a sensitive marker of ventricular arrhythmias in several cardiomyopathies. We aimed to verify the possible association between ventricular arrhythmias and mechanical dispersion in patients with chronic Chagas cardiomyopathy (ChD).
Methods: We included otherwise healthy patients with chronic ChD in a cross sectional echocardiographic study. MD was defined as the standard deviation of time from onset of Q/R on ECG to peak longitudinal strain in 16 segments. Non-sustained ventricular tachycardia (NSVT) by Holter monitoring was defined as complex ventricular arrhythmia. Included patients were split into two groups according to absence (GROUP 0) or presence (GROUP 1) of NSVT by Holter.
Results: We included 76 ChD patients (55±10 years, 60% men). GROUP 0 had 44 patients and GROUP 1 had 32 patients. Patients with NSVT (GROUP 1) had more pronounced MD (59±15ms vs. 87±49ms, p=0.006) and worse GLS (-14.4±2.9% vs. -12.5±4.2, p=0.02) than patients without NSTV (GROUP 0), while LVEF (44±6% vs 42±9%, p=0.57), end-diastolic diameter (61±6 mm vs 62±7 mm, p=0.9) and diastolic function (E/e' 10.2±4.4 vs. 11.7±4.9, p=0.19) were similar. Both MD and GLS were univariate predictors of CVA (P<0.01). MD was independently associated with non-sustained ventricular tachycardia (OR 1.04; 95% CI, 1.00–1.20; p=0.031) in a multivariate analysis
Conclusion: MD was the only echocardiography parameter associated with NSVT in Chagas disease cardiomyopathy and may add important information in the risk stratification of those patients. Better knowledge of pathophysiological and pathogenetic mechanisms, through new methodologies, should allow better therapeutic management and knowledge of earlier risk factors to worse prognosis and stratification of patients.
ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
