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Association between ventricular arrhythmogenicity and myocardial mechanical dispersion assessed by strain echocardiography in chagas cardiomyopathy.

Session Echocardiography in non-ischemic cardiomyopathies

Speaker Alda Cristina Azevedo

Event : ESC Congress 2018

  • Topic : imaging
  • Sub-topic : Tissue Doppler, Speckle Tracking and Strain Imaging
  • Session type : Moderated Posters

Authors : ACA Azevedo (Belo Horizonte,BR), M V Barros (Vespasiano,BR), LG Klaboe (Oslo,NO), T Edvardsen (Oslo,NO), MCP Nunes (Belo Horizonte,BR), HS Costa (Belo Horizonte,BR), GMM Paixao (Belo Horizonte,BR), JPP Martins (Vespasiano,BR), HR Bernardes (Vespasiano,BR), OR Santos Junior (Belo Horizonte,BR), MOC Rocha (Belo Horizonte,BR)

Authors:
A.C.A. Azevedo1 , M.V. Barros2 , L.G. Klaboe3 , T. Edvardsen4 , M.C.P. Nunes1 , H.S. Costa1 , G.M.M. Paixao1 , J.P.P. Martins2 , H.R. Bernardes2 , O.R. Santos Junior1 , M.O.C. Rocha1 , 1Federal University of Minas Gerais - Belo Horizonte - Brazil , 2Faculdade de Saúde e Ecologia Humana - Vespasiano - Brazil , 3Center for Cardiological Innovation - Oslo - Norway , 4Oslo University Hospital - Oslo - Norway ,

Topic(s):
Tissue Doppler, Speckle Tracking and Strain Imaging

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 250

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.

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