Abstract 16978: Use of 2-D Speckle Tracking Strain to Predict Onset of Cardiomyopathy in Chagas Disease

Introduction: Chagas disease is a major cause of morbidity in Latin America where it affects approximately 8 million people, with highest prevalence in Bolivia. An estimated 20-30% of those infected develop Chagas cardiomyopathy (CC) and clinical heart failure. There is currently a lack of reliable predictors of CC, hindering early identification and treatment of patients at highest risk of progression. Methods: This prospective observational study was conducted at the Hospital San Juan de Dios in Santa Cruz, Bolivia. Between 2016 and 2018, participants with Chagas disease underwent a focused history and physical exam, 12-lead ECG and echocardiogram at baseline and at 1-year follow-up. Participants were assigned cardiac disease severity stages according to ECG findings and systolic function as done by Okamoto et al. Those classified as stage A or B at baseline were selected from the overall cohort, and considered to have developed cardiomyopathy (stage C or D) by structural abnormalities on their follow-up echo. Echocardiograms were analyzed for peak averaged and regional left ventricular global longitudinal systolic strain (GLS) using TomTec Image-Arena software. Baseline GLS was compared between those who progressed and those who did not using two-sample t-tests. Results: Of the 113 participants with stage A or B at baseline, 10 had progressed to stage C or D at follow-up 1 year later. Mean age was similar in the two groups, however those who progressed were more likely to be male (see table). At baseline, mean LVEF was lower and peak GLS was less negative among those who progressed compared to those who did not. These differences were similar at the follow-up visit. Conclusion: Mild abnormalities in GLS identify patients with Chagas disease with a higher risk of developing cardiomyopathy within 1 year. Screening for these changes may provide a non-invasive and cost-effective approach to identify patients who could benefit from timely management.