Abstract

LUENGAS, Carlos A; CHAVES, Ángel M  and  VILLAMIZAR, María C. Color M flow velocity propagation is a sensible diastolic disfunction marker in Chagas cardiomyopathy. Rev. Col. Cardiol. [online]. 2008, vol.15, n.6, pp.282-288. ISSN 0120-5633.

Introduction and Objectives: Chagasic myocardiopathy is a severe health problem in Latin America. It is the first cause of dilated cardiopathy of infectious origin in Colombia.The changes described in the evaluation of the diastolic function of patients with cardiopathy are precocious and generally precede symptoms and changes in systolic function. The objective of this study is to understand the behavior of the different variables, to evaluate the diastolic function in patients at different stages of Chagas disease, and to establish whether there are early alterations that can be predictive of the progression rate of the disease. Methods: We evaluated systolic and diastolic ventricular functions in 600 patients distributed as follows: 165 (27.5%) asymptomatic patients, seronegative for Chagas disease (group 0); 277 (46.2%) seropositive asymptomatic patients (group I); 116 (19.3%) seropositive with right bundle branch block (group II); and 42 (7%) seropositive with heart failure (group III). Mitral, tricuspid and pulmonary vein flows, Doppler of mitral and tricuspid rings, color-M mode Doppler flow propagation velocity and Tei index were measured. For the descriptive analysis, the type of variable was taken into account. To establish the frequencies behavior, the Shapiro-Wilk test was used. The difference between the clinical groups was estimated by using group 0 as a baseline through Student’s t-test or Mann-Whitney, depending on the distribution. Statistical analysis was realized using the Stata 8.0 with a <0.05 significant difference. Results: 62.5% of the subjects were men with mean age 41.61 ± 9.38 years. The distribution among the groups was 27.5% group 0; 46.2% group I; 19.3% group II; 7% group III. For the diameter variables,, ventricular volumes and ejection fraction, a clinical deterioration among the groups was observed. Decrease of E/A relation, ,prolongation of deceleration time, A duration and isometric relaxation time (p= 0.0054; p=0.0001; p=0.0001) respectively was evidenced up to group III with a change in the measures tendency between the different groups. In the pulmonary veins the velocity of A and its duration increased in group III (p=0.007; p=0.02 respectively). There was an increment in mitral ring E/E’ relation only in group III (p=0.0001). A decrease in mitral ring E and S velocities and of the tricuspid ring E velocity and prolongation of right ventricular isovolumetric contraction time starting from group III, was noticed. The velocity of color-M mitral flow propagation presented a constant diminution from group I to group III (p=0.01; p=0.005; p=0.0002). The E velocity of the tricuspid ring also diminished in the same way (p=0.08; p=0.03; p=0.0001). The Tei index did not show significant changes between the groups. Conclusion: The diminution of the color-M mitral flow propagation velocity under 72 cm/s was the most sensible variable for the detection of left diastolic ventricular dysfunction in patients with Chagas myocardiopathy.

Keywords : Chagas myocardiopathy; echocardiography; diastolic function.

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