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. 2021 Nov 4;16(11):e0258767.
doi: 10.1371/journal.pone.0258767. eCollection 2021.

Accuracy and reliability of focused echocardiography in patients with Chagas disease from endemic areas: SaMi-Trop cohort study

Isabella Morais Martins Barros  1 , Marcio Vinicius L Barros  1 , Larissa Natany Almeida Martins  2 , Antonio Luiz P Ribeiro  1   3 , Raul Silva Simões de Camargo  3 , Claudia Di Lorenzo Oliveira  4 , Ariela Mota Ferreira  5 , Lea Campos de Oliveira  6 , Ana Luiza Bierrenbach  7 , Desireé Sant Ana Haikal  5 , Ester Cerdeira Sabino  8 , Clareci S Cardoso  4 , Maria Carmo Pereira Nunes  1   3
Affiliations

Accuracy and reliability of focused echocardiography in patients with Chagas disease from endemic areas: SaMi-Trop cohort study

Isabella Morais Martins Barros et al. PLoS One. .

Abstract

Background: Chagas disease remains a major cause of cardiovascular death in endemic areas. Focused echocardiography (FoCUS) is a point-of-care means of assessing cardiac function which can be useful for the diagnosis of cardiac involvement.

Objective: This study aims evaluating the characteristics of validity and reliability of FoCUS applied on Chagas disease patients.

Methods: Patients with Chagas disease coming from an endemic area were selected from a large cohort (SaMi-Trop). A simplified echocardiogram with only three images was extracted from the conventional echocardiogram performed in this cohort. The images were evaluated by an observer who was blinded to the clinical and echocardiographic data, to determine the accuracy and reliability of FoCUS for cardiac assessment. The analysis constituted of 5 prespecified variables, dichotomized in absence or presence: left ventricular (LV) size and systolic function, right ventricular (RV) size and systolic function, and LV aneurysm.

Results: We included 725 patients with a mean age of 63.4 ± 12.3 years, 483 (67%) female. Abnormal electrocardiogram was observed in 81.5% of the patients. Left and right ventricular dysfunctions were found in 103 (14%) and 49 (7%) of the patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 84%, 94%, 70% and 97% for LV enlargement and 81%, 93%, 68% and 97% for LV systolic dysfunction, respectively, and 46%, 99%, 60% and 98% for RV dilatation, and 37%, 100%, 100% and 96% for RV dysfunction, respectively. Inter and intraobserver agreement were 61% and 87% for LV enlargement and 63% and 92% for LV dysfunction, respectively, and 50% and 49% for RV size and 46% and 79% for RV dysfunction, respectively. LV apical aneurysm was found in 45 patients (6.2%) with the lowest sensitivity of FoCUS study (11%; 95% CI 2-28%).

Conclusions: FoCUS showed satisfactory values of validity and reliability for assessment of cardiac chambers in patients with Chagas disease, except for apical aneurysm. This tool can identify heart disease with potential impact on patient management in the limited-resource setting.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Echocardiographic views selected for the focused echocardiogram.
A: Parasternal long-axis view; B: Apical four-chamber view; C: Apical two-chamber view. LA: left atrium; RA: right atrium; LV: left ventricle; RV: right ventricle.
Fig 2
Fig 2. Echocardiographic studies of Chagas disease patients.
A: akinesia of inferior wall, basal segment; B: akinesia of lateral basal wall, basal segment; C and D: LV apical aneurysm; E: LV apical thrombus; F: right-sided chambers dilation. LA: left atrium; RA: right atrium; LV: left ventricle; RV: right ventricle.
Fig 3
Fig 3. Management of patients with Chagas disease based on FoCUS results.
A proposed approach based on left ventricular systolic function assessed by focused echocardiography.
See this image and copyright information in PMC

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