Association between cardiorenal biomarkers and myocardial deformation parameters in Chagas cardiomyopathy: a speckle tracking echocardiography study

Background Early detection of myocardial involvement in Chagas disease is crucial for timely intervention and improved clinical outcomes. While speckle tracking echocardiography (STE) provides sensitive insights into left ventricular mechanics through global longitudinal strain (GLS), its availability is often limited in endemic and low-resource areas. Identifying circulating biomarkers that accurately reflect subclinical myocardial dysfunction could significantly enhance early diagnosis and risk stratification in this population. Purpose This study aimed to evaluate the association between a comprehensive panel of cardiorenal biomarkers, including NT-proBNP, high-sensitivity cardiac troponin T (hs-cTnT), galectin-3, soluble ST2 (sST2), neutrophil gelatinase-associated lipocalin (NGAL), and cystatin C, and myocardial deformation parameters assessed by STE in patients with chronic Chagas cardiomyopathy (CCC). Methods We conducted a cross-sectional study of 100 patients with confirmed CCC (median age 62 years; 55% male; median LVEF 42%). All participants underwent echocardiography with STE to evaluate global and segmental longitudinal strain. Six biomarkers were measured using standard assays. Correlations were analysed using Spearman’s coefficient, and multiple linear regression models, adjusted for age, sex, BMI, and NYHA class, were employed to quantify the proportion of variance (R²) in strain parameters explained by each biomarker. Robustness was ensured through bootstrap resampling with 1.000 iterations. Results Significant associations were observed between all measured biomarkers and GLS. NT-proBNP demonstrated the strongest correlation (rho=0.82, p<0.001) and explained the highest variance in GLS (adjusted R² 0.70; 95% CI 0.57-0.77) after adjusting for covariates. This was followed by cystatin C (R² 0.50), hs-cTnT (R² 0.49), and NGAL (R² 0.49), while sST2 and galectin-3 showed more modest associations (R² 0.37 and 0.36, respectively) (figure 1). Furthermore, NT-proBNP exhibited the most consistent relationships with regional strain, particularly within mid-ventricular segments, effectively capturing the heterogeneous pattern of myocardial impairment characterised by Chagas disease (figure 2). Conclusion(s) Among the evaluated biomarkers, NT-proBNP best reflects both global and regional myocardial dysfunction in patients with CCC. These findings underscore its potential as a reliable and accessible surrogate for myocardial deformation, particularly in resource-limited settings where advanced imaging techniques are unavailable. A multi-marker strategy incorporating NT-proBNP may significantly improve the diagnostic and prognostic assessment of cardiac involvement in this vulnerable population.Figure 1.Bulls-eye grid biomarkers vs strainFigure 2.