Fast-SENC CMR detected a median of 4 LV segments with abnormal strain vs. 1 by TTE in early Chagas cardiomyopathy, showing superior diagnostic accuracy (p=0.002).
Does fast-SENC CMR improve the detection of regional wall motion abnormalities compared to TTE in patients with early-stage Chagas cardiomyopathy?
Fast-SENC CMR demonstrates higher diagnostic accuracy than echocardiography for detecting subtle regional wall motion abnormalities in early-stage Chagas cardiomyopathy.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Chagas disease is one of the most prevalent infectious diseases in Latin America and has become a significant health concern in non-endemic countries. Accurate and timely diagnosis of cardiac involvement is crucial for assessing patient prognosis and guiding clinical management. Segmental left ventricular (LV) wall motion abnormalities emerge in the early stages of cardiac involvement. However, the detection of regional wall motion abnormalities through visual assessment is subjective, and subtle changes in segmental contractility may not be identified using transthoracic echocardiography (TTE). This study aims to evaluate the role of cardiac magnetic resonance (CMR) with quantitative segmental myocardial strain analysis in the assessment of early stages of Chagas cardiomyopathy, comparing its diagnostic accuracy to echocardiographic evaluation. Purpose Fast Strain-ENCoded (fast-SENC) CMR is a novel technique enabling strain analysis within a single heartbeat, without breath-holding, and with higher spatial resolution than previous CMR strain analysis methods. We hypothesize that LV myocardial strain assessment using fast-SENC CMR may be superior to TTE in detecting LV wall motion abnormalities in this population. This could lead to earlier and more accurate diagnosis and risk stratification of Chagas cardiomyopathy, improving disease management. Methods The study included patients with serologically confirmed Chagas disease and electrocardiographic abnormalities indicative of Chagas cardiomyopathy. All were classified as stage B1 of Chagas cardiomyopathy with normal ventricular function and no symptoms of heart failure. TTE was performed including global longitudinal strain (GLS) assessment. CMR was conducted using fast-SENC sequences to evaluate segmental longitudinal and circumferential strain and identify dysfunctional segments. The study compared the diagnostic performance of both techniques in detecting regional wall motion abnormalities. Results A total of 14 participants were included in the study. Baseline characteristics, TTE results and CMR findings are summarized in Table 1. The distribution of LV segments with abnormal GLS using both techniques is shown in Figure 1, with predominance in the inferior, inferolateral and apical segments. Non-parametric matched pair analysis (Wilcoxon Test) for LV segments with altered GLS was performed favouring fast-SENC CMR (median 4, IQR 2-8) over TTE [median 1, IQR 0-3) showing statistical significance (p=0.002). Conclusions Fast-SENC CMR sequence showed high diagnostic accuracy compared to echocardiography for the detection of regional wall motion abnormalities in early stages of Chagas cardiomyopathy. This may be explained by the fact that the most common locations of regional wall motion abnormalities (inferior and apical segments) can be subtle and may be missed by TTE. These findings support our aim to further investigate within this clinical scenario with a larger sample size.
Hernandez et al. (Sat,) reported a other. Fast-SENC CMR detected a median of 4 LV segments with abnormal strain vs. 1 by TTE in early Chagas cardiomyopathy, showing superior diagnostic accuracy (p=0.002).