1Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain.
2Department of Cardiology, Navarra University Clinic, Madrid, Spain.
Am J Trop Med Hyg. 2020 Oct;103(4):1480-1486. doi: 10.4269/ajtmh.20-0389.
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.
恰加斯病是欧洲和其他非流行地区的一种新发传染病，主要是由于从流行地区移民所致。我们旨在研究高级超声心动图（ECHO）和心脏磁共振（CMR）在新诊断的恰加斯病患者中的价值，以比较其与心电图（ECG）和常规 ECHO 的结果，从而发现心脏异常。我们纳入了连续诊断为恰加斯病且已登记心脏检查结果（ECG、ECHO 和 CMR）的患者。我们将 ECHO 参数分为三层：1）左心室射血分数、局部壁运动异常和左心室舒张末径（ECHO-1）；2）其他常见 ECHO 参数（ECHO-2）；3）整体纵向应变（GLS）（ECHO-3）。心脏磁共振包括全心和节段性双心室功能、心肌纤维化和水肿的存在。该研究纳入了来自南美洲的 100 名患者。平均年龄为 43.9 ± 0.9 岁，66%为女性。平均在西班牙居住时间为 9.7 ± 0.5 年。心电图显示 47%的患者有≥2 项异常发现。ECHO-1 异常的患者占 22%，ECHO-2 异常的患者占 52%，GLS 异常的患者占 16%。心脏磁共振异常的患者占 50%，其中 3%的患者 ECHO 正常。当心电图和常规 ECHO 联合使用时，83%的患者存在异常。GLS 和 CMR 的异常检出率分别增加至 86%和 92%。这些结果表明，心电图和常规 ECHO 应作为新诊断的恰加斯病患者的常规标准心脏检查。高级 ECHO 技术和 CMR 的价值较低。
