Diagnostic impact of contrast echocardiography in chronic chagas disease: a single-centre experience

Background and Purpose Chronic Chagas cardiomyopathy is a progressive condition associated with myocardial fibrosis, conduction abnormalities, and risk of sudden cardiac death. Despite its clinical significance, echocardiography remains underutilized in many regions. This ongoing study aims to characterize the baseline clinical and echocardiographic features of patients with chronic Chagas disease and to assess the added diagnostic value of contrast-enhanced echocardiography in this population. Methods We evaluated baseline clinical and echocardiographic characteristics of 55 patients with chronic Chagas disease enrolled in a prospective registry. All patients underwent a comprehensive 2D transthoracic echocardiographic study, including biplane and 3D Left Ventricular Ejection Fraction, left and right atrial measurements, and Global Longitudinal Strain using speckle-tracking imaging. Contrast-enhanced echocardiography was performed in all patients using contrast agents to optimize endocardial border definition. NT-pro BNP and ECG were also assessed. Continuous variables are reported as mean ± standard deviation (SD), and categorical variables as frequencies or percentages. Results The cohort had a mean age of 53.0 ± 7.6 years, and 67% were female. Sinus rhythm with normal QRS complexes was observed in 87% of patients, whilst 11% had sinus rhythm with right bundle branch block (RBBB). NT-proBNP was available in 35 patients. It was elevated only in 1 of the Chagas patients. Left ventricular systolic function was preserved, with a mean LVEF of 61.2 ± 4.0% (3D) and 63.1 ± 5.6% (Biplane). GLS averaged –19.6 ± 2.7%. Left atrial volume was 44.3 ± 14.8 mL, and right atrial area measured 13.7 ± 2.9 cm². Diastolic function indices included an E/A ratio of 1.17 ± 0.9 and an average E/e′ of 6.9 ± 1.9. Small apical aneurysms were identified in 2 patients using 2D echocardiography, and in 5 additional patients using contrast-enhanced echocardiography. Regional wall motion abnormalities were identified in 2 patients on 2D imaging and in 3 additional patients following contrast enhancement. Conclusion Contrast-enhanced echocardiography significantly improves the detection of small apical aneurysms and regional wall motion abnormalities in patients with Chagas disease. The majority of RWMAs and apical aneurysms were not detectable and would have been overlooked without contrast echo. These findings support its routine use, particularly in patients with limited 2D image quality, to optimize diagnostic sensitivity and guide clinical decision-making. Our results highlight the potential for standardizing contrast-enhanced protocols in this population to improve diagnostic confidence and outcomes.