Accuracy and reliability of focused echocardiography in patients with Chagas disease from endemic areas: SaMi-Trop cohort study

• Published in: PloS one Vol. 16; no. 11; p. e0258767
• Main Authors: Martins Barros, Isabella Morais, Barros, Marcio Vinicius L, Almeida Martins, Larissa Natany, Ribeiro, Antonio Luiz P, de Camargo, Raul Silva Simões, Oliveira, Claudia Di Lorenzo, Ferreira, Ariela Mota, de Oliveira, Lea Campos, Bierrenbach, Ana Luiza, Haikal, Desireé Sant Ana, Sabino, Ester Cerdeira, Cardoso, Clareci S, Nunes, Maria Carmo Pereira
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04-11-2021; Public Library of Science (PLoS)
• Subjects: Aged; Akinesia; Aneurysm; Aneurysms; Biology and Life Sciences; Cardiomyopathy; Cardiovascular diseases; Chagas Cardiomyopathy - diagnosis; Chagas Cardiomyopathy - diagnostic imaging; Chagas Cardiomyopathy - physiopathology; Chagas disease; Chagas Disease - diagnosis; Chagas Disease - diagnostic imaging; Chagas Disease - physiopathology; Cohort analysis; Coronary artery disease; Diagnosis; Echocardiography; EKG; Electrocardiography; Enlargement; Evaluation; Female; Heart - diagnostic imaging; Heart - physiopathology; Heart diseases; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Hospitals; Humans; Infectious diseases; Male; Medical imaging; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Patients; Primary care; Reliability analysis; Research and Analysis Methods; Sensitivity; Systole - physiology; Ultrasonic imaging; Vector-borne diseases; Ventricle; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology; Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0258767

Chagas disease remains a major cause of cardiovascular death in endemic areas. Focused echocardiography (FoCUS) is a point-of-care means of assessing cardiac function which can be useful for the diagnosis of cardiac involvement.
This study aims evaluating the characteristics of validity and reliability of FoCUS applied on Chagas disease patients.
Patients with Chagas disease coming from an endemic area were selected from a large cohort (SaMi-Trop). A simplified echocardiogram with only three images was extracted from the conventional echocardiogram performed in this cohort. The images were evaluated by an observer who was blinded to the clinical and echocardiographic data, to determine the accuracy and reliability of FoCUS for cardiac assessment. The analysis constituted of 5 prespecified variables, dichotomized in absence or presence: left ventricular (LV) size and systolic function, right ventricular (RV) size and systolic function, and LV aneurysm.
We included 725 patients with a mean age of 63.4 ± 12.3 years, 483 (67%) female. Abnormal electrocardiogram was observed in 81.5% of the patients. Left and right ventricular dysfunctions were found in 103 (14%) and 49 (7%) of the patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 84%, 94%, 70% and 97% for LV enlargement and 81%, 93%, 68% and 97% for LV systolic dysfunction, respectively, and 46%, 99%, 60% and 98% for RV dilatation, and 37%, 100%, 100% and 96% for RV dysfunction, respectively. Inter and intraobserver agreement were 61% and 87% for LV enlargement and 63% and 92% for LV dysfunction, respectively, and 50% and 49% for RV size and 46% and 79% for RV dysfunction, respectively. LV apical aneurysm was found in 45 patients (6.2%) with the lowest sensitivity of FoCUS study (11%; 95% CI 2-28%).
FoCUS showed satisfactory values of validity and reliability for assessment of cardiac chambers in patients with Chagas disease, except for apical aneurysm. This tool can identify heart disease with potential impact on patient management in the limited-resource setting.