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BIOMARKERS AND ECHOCARDIOGRAPHIC PREDICTORS OF CARDIOVASCULAR OUTCOME IN PATIENTS WITH CHRONIC CHAGAS DISEASE
Ecocardiografia tridimensional
Doença de Chagas
Mortalidade
Prognóstico
Mortality
Prognosis
Dimensional strain analysis
Dimensional echocardiography
Author
Mendes, Veronica G.
Rimolo, Lorena
Lima, Ana Carolina B. de
Ferreira, Roberto R.
Oliveira, Luciano S.
Nisimura, Lindice M.
Horita, Samuel I. M.
Costa, Andréa R.
Silva, Gilberto Marcelo S. da
Sangenis, Luiz Henrique C.
Mendes, Fernanda S. N. S.
Sousa, Andrea S.
Veloso, Henrique H.
Holanda, Marcelo T.
Mediano, Mauro F. F.
Waghabi, Mariana C.
Garzoni, Luciana R.
Moreira, Otacílio C.
Britto, Constança
Cunha, Ademir B.
Hasslocher-Moreno, Alejandro Marcel
Saraiva, Roberto M.
Rimolo, Lorena
Lima, Ana Carolina B. de
Ferreira, Roberto R.
Oliveira, Luciano S.
Nisimura, Lindice M.
Horita, Samuel I. M.
Costa, Andréa R.
Silva, Gilberto Marcelo S. da
Sangenis, Luiz Henrique C.
Mendes, Fernanda S. N. S.
Sousa, Andrea S.
Veloso, Henrique H.
Holanda, Marcelo T.
Mediano, Mauro F. F.
Waghabi, Mariana C.
Garzoni, Luciana R.
Moreira, Otacílio C.
Britto, Constança
Cunha, Ademir B.
Hasslocher-Moreno, Alejandro Marcel
Saraiva, Roberto M.
Affilliation
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Fluminense Federal University. Antonio Pedro University Hospital. Niterói, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Molecular Biology and Endemic Diseases Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Applied Genomics and Bioinnovations. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Innovations in Therapies. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Innovations in Therapies, Education and Bioproducts. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Applied Genomics and Bioinnovations. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Innovations in Therapies, Education and Bioproducts. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Molecular Virology and Parasitology. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Molecular Biology and Endemic Diseases Laboratory. Rio de Janeiro, RJ, Brazil.
Fluminense Federal University. Antonio Pedro University Hospital. Niterói, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Fluminense Federal University. Antonio Pedro University Hospital. Niterói, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Molecular Biology and Endemic Diseases Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Applied Genomics and Bioinnovations. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Innovations in Therapies. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Innovations in Therapies, Education and Bioproducts. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Applied Genomics and Bioinnovations. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Innovations in Therapies, Education and Bioproducts. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Molecular Virology and Parasitology. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Molecular Biology and Endemic Diseases Laboratory. Rio de Janeiro, RJ, Brazil.
Fluminense Federal University. Antonio Pedro University Hospital. Niterói, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Chagas Disease Evandro Chagas National Institute of Infectious Diseases. Clinical Research Laboratory. Rio de Janeiro, RJ, Brazil.
Abstract
Background: Chagas disease (CD) presents an ominous prognosis. The predictive value of biomarkers and new echocardiogram parameters in adjusted models have not been well studied. Methods and Results: There were 361 patients with chronic CD (57.6% men, 61±11 years of age, clinical forms: indeterminate 27.1%, cardiac 56.6%, digestive 3.6%, cardiodigestive 12.7%) included in this single-center, observational, prospective longitudinal study. Echocardiographic evaluation included strain analyses of left atrial, left ventricular (LV), and right ventricular and 3-dimensional analyses of left atrial and LV volumes. Biomarkers included cardiac troponin I, brain natriuretic peptide, transforming growth factor β1, tumor necrosis factor, matrix metalloproteinases, and Trypanosoma cruzi polymerase chain reaction. The studied end point was a composite of CD-related mortality, heart transplant, hospital admission due to worsening heart failure, or new cardiac device insertion. Event-free survival was analyzed by multivariable regression analyses adjusted for competing risks. P values <0.05 were considered significant. The composite event occurred in 79 patients after 4.9±2.0 years follow-up. LV end-diastolic volume (hazard ratio [HR], 1.01 [95% CI, 1.00-1.02]; P=0.02), peak negative global atrial strain (HR, 1.08 [95% CI, 1.00-1.17]; P=0.04), LV global circumferential strain (HR, 1.12 [95% CI, 1.04-1.21]; P=0.003), LV torsion (HR, 0.55 [95% CI, 0.35-0.81]; P=0.003), brain natriuretic peptide (HR, 2.03 [95% CI, 1.23-3.34]; P=0.005), and positive T cruzi polymerase chain reaction (HR, 1.80 [95% CI, 1.12-2.91]; P=0.01) were end point predictors independent from age, sex, 2-dimensional echocardiographic indexes, hypertension, previous cardiac device, and CD cardiac form. Conclusions: Two-dimensional strain- and 3-dimensional-derived parameters, brain natriuretic peptide, and positive T cruzi polymerase chain reaction can be useful for prediction of CD cardiovascular events.
Keywords in Portuguese
Análise de tensão bidimensionalEcocardiografia tridimensional
Doença de Chagas
Mortalidade
Prognóstico
Keywords
Chagas diseaseMortality
Prognosis
Dimensional strain analysis
Dimensional echocardiography
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