Comparison of Noninvasive Cardiac Test Strategies for Newly Diagnosed Chagas Disease in a Non-Endemic Zone

Abstract

Chagas disease is an emerging infectious disease in Europe and other non-endemic areas, mainly owing to migration from endemic areas. We aimed at investigating the value of advanced echocardiography (ECHO) and cardiac magnetic resonance (CMR) in patients newly diagnosed with Chagas disease to compare findings with those of electrocardiogram (ECG) and conventional ECHO and thus detecting cardiac abnormalities. We included consecutive patients with newly diagnosed Chagas disease and registered cardiac test results (ECG, ECHO, and CMR). We divided ECHO parameters into three tiers: 1) left ventricular ejection fraction, regional wall motion abnormality, and left ventricular diastolic dimension (ECHO-1); 2) other common ECHO parameters (ECHO-2); and 3) global longitudinal strain (GLS) (ECHO-3). Cardiac magnetic resonance included global and segmental biventricular function, the presence of myocardial fibrosis, and edema. The study comprised 100 patients from South America. The mean age was 43.9 ± 0.9 years, and 66% were women. Mean time living in Spain was 9.7 ± 0.5 years. The ECG revealed ≥ 2 abnormal findings in 47% of patients. ECHO-1 was abnormal in 22% of patients, ECHO-2 in 52%, and GLS in 16%. Cardiac magnetic resonance was abnormal in 50% of cases, and in 3% of these, ECHO was normal. When ECG and conventional ECHO were taken together, abnormalities were detected in 83% of patients. This value increased to 86% and 92% for GLS and CMR, respectively. These findings suggest that ECG and conventional ECHO should be used routinely as standard cardiac tests for newly diagnosed cases of Chagas disease. The value of advanced ECHO techniques and CMR is low.

Figure 1.

Abnormal cardiac findings using different diagnostic techniques. ECG: BENEFIT criteria; Echocardiography (ECHO)-1: BENEFIT criteria; ECHO-2: any other conventional 2D-echo Doppler abnormal finding; ECHO-3: abnormal global longitudinal strain; cardiac magnetic resonance (CMR): any abnormal finding in CMR imaging. This figure appears in color at www.ajtmh.org.

Figure 2.

Combining diagnostic techniques increased the number of patients presenting some abnormal findings. ECG: BENEFIT criteria. Echocardiography (ECHO)-1: BENEFIT criteria; ECHO-2: any other abnormal finding in conventional 2D-echo Doppler; ECHO-3: abnormal global longitudinal strain; cardiac magnetic resonance (CMR): any abnormal finding in CMR imaging. This figure appears in color at www.ajtmh.org.

Figure 3.

Progressive myocardial injury and left ventricular dysfunction and evidence-based treatment recommended in clinical practice guidelines. Both American Society of Echocardiography/InterAmerican Association of Echocardiography stages (blue boxes). HF = clinical heart failure; HFrEF/HFmrEF/HFpEF = heart failure with reduced, mid-range; LV = left ventricle; LVD = left ventricular dysfunction; LVF = left ventricular function, and preserved ejection fraction, respectively. This figure appears in color at www.ajtmh.org.