Longitudinal Speckle Tracking Strain Abnormalities in Chagas Disease: A Systematic Review and Meta-Analysis

Sergio Alejandro Gómez-Ochoa; Lyda Z Rojas; Juliana Alexandra Hernández-Vargas; Jorge Largo; Taulant Muka; Luis E Echeverría

doi:10.3390/jcm11030769

Longitudinal Speckle Tracking Strain Abnormalities in Chagas Disease: A Systematic Review and Meta-Analysis

J Clin Med. 2022 Jan 31;11(3):769. doi: 10.3390/jcm11030769.

Authors

Sergio Alejandro Gómez-Ochoa¹, Lyda Z Rojas², Juliana Alexandra Hernández-Vargas³, Jorge Largo⁴, Taulant Muka¹, Luis E Echeverría⁵

Affiliations

¹ Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland.
² Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Fundación Cardiovascular de Colombia, Floridablanca 680004, Colombia.
³ Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá 111711, Colombia.
⁴ Internal Medicine Department, Universidad Militar Nueva Granada, Bogotá 110010, Colombia.
⁵ Heart Failure and Heart Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca 680004, Colombia.

Abstract

Background: Chronic Chagas cardiomyopathy (CCM) is ranked among heart failure etiologies with the highest mortality rates. CCM is characterized by alterations in left ventricular function with a typical and unique pattern of myocardial involvement. Left ventricle longitudinal speckle tracking strain is emerging as an important additive method for evaluating left ventricular function and risk of future cardiovascular events. This systematic review aimed to characterize the left ventricle (LV) longitudinal strain by speckle tracking patterns in the different stages of Chagas disease, compared to healthy controls.

Methods: Searches in Medline, EMBASE, and LILACS databases (from inception to 20 May 2021) were performed. Articles written in any language that assessed patients with Chagas disease and reported any measures derived from the left ventricular strain by speckle tracking were included. Two reviewers independently selected the studies, extracted the data, and assessed the quality of evidence. Standardized mean differences (SMD) were pooled using random-effects meta-analyses.

Results: Of 1044 references, ten studies, including a total of 1222 participants (CCM: 477; indeterminate form: 444; healthy controls: 301), fulfilled the selection criteria and were included in the final analysis. Patients with CCM had a significantly higher mean global longitudinal strain (GLS) value than indeterminate form (IF) patients (SMD 1.253; 95% CI 0.53, 1.98. I² = 94%), while no significant difference was observed between IF patients and healthy controls (SMD 0.197; 95% CI -0.19, 0.59. I² = 80%). Segmental strain analyses revealed that patients with the IF form of CD had significantly worse strain values in the basal-inferoseptal (SMD 0.49; 95% CI 0.24, 0.74. I²: 24%), and mid-inferoseptal (SMD 0.28; 95% CI 0.05, 0.50. I²: 10%) segments compared to healthy controls.

Conclusions: Our results suggest different levels of functional derangements in myocardial function across different stages of Chagas disease. Further research is needed to assess the prognostic role of LV longitudinal strain and other measures derived from speckle tracking in CD patients regarding progression to cardiomyopathy and clinical outcomes prediction.

Keywords: Chagas disease; echocardiography; speckle tracking strain.

Publication types

Review