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Original Articles • Arq. Bras. Cardiol. 105 (1) • July 2015 • https://doi.org/10.5935/abc.20150045 copy

Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background:

Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks.

Objective:

To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions.

Methods:

10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging.

Results:

Reservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e’_average with the reservoir and pump functions (TEF and AEF), and a positive correlation of e’_average with s’ wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions.

Conclusion:

An impairment of LA functions in Chagas cardiomyopathy was observed.

Chagas Disease; Chagas Cardiomyopathy; Ventricular Dysfunction; Atrial Function/physiopathology; Echocardiography; Doppler/methods

Variables	CG (n = 10)	GI (n = 26)	GII (n = 30)	GIII (n = 19)	p
Variables	mean ± SD	mean ± SD	mean ± SD	mean ± SD	p
Age (years)	40 ± 6	46 ± 6	43 ± 8	43 ± 7	0.11
Weight (kg)	68 ± 13	68 ± 12	68 ± 11	71 ± 13	0.82
Height (cm)	162 ± 8	163 ± 7	162 ± 9	164 ± 10	0.88
BSA (m²)	1.70 ± 0.2	1.72 ± 0.2	1.70 ± 0.2	1.80 ± 0.2	0.79
SBP (mm Hg)	109 ± 9	114 ± 10	118 ± 12	109 ± 10	0.05
DBP (mm Hg)	70 ± 9	73 ± 8	72 ± 8	67 ± 8	0.14
HR (bpm)	68 ± 10	70 ± 9	67 ± 9	64 ± 10	0.16

Variables	CG (n = 10)	GI (n = 26)	GII (n = 30)	GIII (n = 19)	p
Variables	mean ± SD	mean ± SD	mean ± SD	mean ± SD	p
LVDD (mm/m²)	25 ± 2.1	25.9 ± 2.3	28.4 ± 3.3^# # GII values significantly different from CG values	37.1 ± 5.0^* * GIII values significantly different from those of other groups	< 0.0001
LAV_max(ml/m²)	23 ± 4.5	27 ± 6.4	31 ± 8.7^# # GII values significantly different from CG values	42 ± 12.1^* * GIII values significantly different from those of other groups	< 0.0001
LAV_{pre P}(ml/m²)	14 ± 3	17 ± 4.21	21 ± 6.5^# # GII values significantly different from CG values	32 ± 12^* * GIII values significantly different from those of other groups	< 0.0001
LAV_mín(ml/m²)	8.5 ± 2	9.8 ± 2.9	12.3 ± 5.9	24 ± 10.9^* * GIII values significantly different from those of other groups	< 0.0001

Variables	CG (n = 10)	GI (n = 26)	GII (n = 30)	GIII (n = 19)	p
Variables	mean ± SD	mean ± SD	mean ± SD	mean ± SD	p
E wave (cm/s)	74.2 ± 12.7	71.9 ± 14.4	71.2 ± 17.4	68 ± 19.4	0.7635
A wave (cm/s)	54.1 ± 4.9	62.5 ± 7.9	59.7 ± 12.0	58.9 ± 16.9	0.0949
E/A	1.4 ±0.2	1.2 ± 0.3	1.2 ± 0.4	1.3 ± 0.6	0.2279
DTE (ms)	174.4 ± 18.1	198.8 ± 30.7	198.9 ± 33.1	210 ± 64.6	0.1836
LVEF	0.67 ± 0.05	0.66 ± 0.04	0.67 ± 0.06	0.41 ± 0.07^* * GIII values significantly different from those of other groups CG: control group; GI: indeterminate form; GII: electrocardiographic abnormalities and LV ejection fraction ≥ 0.55; GIII: electrocardiographic abnormalities and LV ejection fraction < 0.55; E wave: E wave in mitral flow; A wave: A wave in mitral flow; E/A: E wave/A wave ratio; DTE: E wave deceleration time; LVEF: left ventricular ejection fraction.	< 0.0001

Variables	CG (n = 10)	GI (n = 26)	GII (n = 30)	GIII (n = 19)	p
Variables	mean ± SD	mean ± SD	mean ± SD	mean ± SD	p
S'_lat	11.4 ± 2.2	13.2 ± 2.0	13.5 ± 2.7	8.0 ± 1.9^* * GIII values significantly different from those of other groups	< 0.0001
e'_lat	15 ± 2.3	15.1 ± 3.2	13.3 ± 3.1	9.8 ± 3.7^* * GIII values significantly different from those of other groups	0.0004
s'_sep	9.2 ± 2.8	10.6 ± 1.5	10.5 ± 2.0	7.3 ± 1.8^* * GIII values significantly different from those of other groups	< 0.0001
e'_sep	11.0 ± 2.1	10.5 ± 2.3	9.7 ± 1.8	7 ± 1.5^* * GIII values significantly different from those of other groups	< 0.0001
e'_average	13 ± 1.6	12.8 ± 2.5	11.3 ± 2.5	8.1 ± 2.6^* * GIII values significantly different from those of other groups	< 0.0001
E/e'_average	5.8 ± 1.5	5.7 ± 0.8	6.6 ± 2.3	9.6 ± 3.4^* * GIII values significantly different from those of other groups	< 0.0001

Variables	CG (n = 10)	GI (n = 26)	GII (n = 30)	GIII (n = 19)	P
Variables	mean ± SD	mean ± SD	mean ± SD	mean ± SD	P
AEF (mL)	0.38 ± 0.05	0.44 ± 0.08	0.42 ± 0.11	0.27 ± 0.11*	0.0001
TEF (mL)	0.63 ± 0.09	0.63 ± 0.08	0.62 ± 0.10	0.44 ± 0.13*	< 0.0001
PEF (mL)	0.39 ± 0.12	0.35 ± 0.10	0.35 ± 0.10	0.23 ± 0.12	0.004

	E/e'average	e'average	LVEF	s'_sep	s'_lat
TEF	r = -0.26	r = 0.53	r = 0.35	r = 0.33	r= 0.28
TEF	p = 0.02	p < 0.001	p = 0.003	p = 0.003	p = 0.003
PEF	r = -0.09	r = 0.49	r = 0.42	r = 0.197	r = 0.118
PEF	p = 0.44	p < 0.001	p < 0.001	p = 0.135	p = 0.378
AEF	r = -0.36	r = 0.39	r = 0.35	r = 0.37	r= 0.34
AEF	p = 0.002	p = 0.001	p = 0.003	p = 0.004	p = 0.01

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