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Review
. 2023 Jun 8;18(1):27.
doi: 10.5334/gh.1207. eCollection 2023.

WHF Recommendations for the Use of Echocardiography in Chagas Disease

Kate Ralston  1 , Ezequiel Zaidel  2   3 , Harry Acquatella  4 , Marcia Melo Barbosa  5 , Jagat Narula  6 , Yu Nakagama  7 , Gustavo Restrepo Molina  8 , Karen Sliwa  9 , Jose Luis Zamorano  10 , Fausto J Pinto  11 , Daniel Jose Piñeiro  12 , Mariana Corneli  13
Affiliations
Review

WHF Recommendations for the Use of Echocardiography in Chagas Disease

Kate Ralston et al. Glob Heart. .

Abstract

Chagas disease (ChD) represents a significant health burden in endemic regions of Latin America and is increasingly being recognized as a global health issue. The cardiac involvement in ChD, known as Chagas cardiomyopathy (ChCM), is the most severe manifestation and a leading cause of heart failure and mortality in affected individuals. Echocardiography, a non-invasive imaging modality, plays a crucial role in the diagnosis, monitoring, and risk stratification of ChCM. This consensus recommendation aims to provide guidance on the appropriate use of echocardiography in ChD. An international panel of experts, including cardiologists, infectious disease specialists, and echocardiography specialists, convened to review the available evidence and provide practical recommendations based on their collective expertise. The consensus addresses key aspects related to echocardiography in ChD, including its role in the initial evaluation, serial monitoring, and risk assessment of patients. It emphasizes the importance of standardized echocardiographic protocols, including the assessment of left ventricular function, chamber dimensions, wall motion abnormalities, valvular involvement, and the presence of ventricular aneurysm. Additionally, the consensus discusses the utility of advanced echocardiographic techniques, such as strain imaging and 3D echocardiography, in assessing myocardial mechanics and ventricular remodeling.

Keywords: Chagas Disease; Echocardiography; aneurysm; cardiomyopathy; heart failure.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Phases of Chagas diseases
Figure 1
Phases of Chagas disease [1].
Views in two and four chambers of the LV where pericardial effusion is identified
Figure 2
Acute Chagas disease. Arrows indicate pericardial effusion in heart failure due to Chagas disease. Image: Mariana Corneli. Reproduced with permission of the photographer.
Four, Two and Three chamber 2D echo views where an apical aneurysm is showed
Figure 3
2D apical 4, 2 and 3-chamber views in a patient with Chagas disease and a typical aneurysm. In the 2-chamber view, a basal inferior aneurysm is also present. Longitudinal strain is abnormal in the apex, as well as on the basal inferior wall. Image: Marcia Barbosa. Reproduced with permission of the photographer.
2D echo four chamber view shows a right ventricular aneurysm
Figure 4
A young patient with Chagas disease presenting with biventricular dysfunction. Arrow in the 4 chamber-view, optimized to visualize the right ventricle, shows the infrequent finding of right ventricular aneurysm. Image: Marcia Barbosa. Reproduced with permission of the photographer.
Echo Doppler evaluation of severe mitral and tricuspid functional regurgitation
Figure 5
Biventricular dysfunction in a patient with Chagas disease. Superior figures show non coaptation of the tricuspid valve (due to right ventricular dilation) and its consequent functional regurgitation. Lower figures show mitral regurgitation secondary to left ventricular dysfunction. Image: Mariana Corneli. Reproduced with permission of the photographer.
See this image and copyright information in PMC

References

    1. Echeverría LE, Marcus R, Novick G, Sosa-Estani S, Ralston K, Zaidel EJ, et al. WHF IASC Roadmap on Chagas Disease. Glob Heart. 2020; 15(1): 26. DOI: 10.5334/gh.484 - DOI - PMC - PubMed
    1. Ribeiro AL, Marcolino MS, Prineas RJ, Lima-Costa MF. Electrocardiographic abnormalities in elderly Chagas disease patients: 10-year follow-up of the Bambui Cohort Study of Aging. J Am Heart Assoc. 2014; 3(1): e000632. DOI: 10.1161/JAHA.113.000632 - DOI - PMC - PubMed
    1. Acquatella H, Asch FM, Barbosa MM, Barros M, Bern C, Cavalcante JL, et al. Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC). J Am Soc Echocardiogr. 2018; 31(1): 3–25. DOI: 10.1016/j.echo.2017.10.019 - DOI - PubMed
    1. Yadav H, Shah D, Sayed S, Horton S, Schroeder LF. Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys. Lancet Glob Health. 2021; 9(11): e1553–e60. DOI: 10.1016/S2214-109X(21)00442-3 - DOI - PMC - PubMed
    1. Norman D, Olaf H. An experimental application of the DELPHI method to the use of experts. Manag Sci. 1963; 9(3): 458–67. DOI: 10.1287/mnsc.9.3.458 - DOI