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Diastolic function is early involved during the undetermined form of Chagas disease. Pulsed Doppler tissue imaging is a new technique to evaluate diastolic function by mean of the record of myocardial velocities in the longitudinal axis. With the purpose to evaluate diastolic function by pulsed Doppler tissue imaging in patients with Chagas disease, we studied with Doppler echocardiography 51 patients (age average 48 +/- 12 years) and 24 normal subjects (age average 47 +/- 15 years) as a control group. Patients were divided in two groups according to the pattern of mitral and pulmonary vein flow: restrictive (17 patients) and no restrictive (35 patients). Peak velocity of E wave of the lateral mitral annulus was diminished in no restrictive and restrictive patients (0.13 +/- 0.04 m/s, 0.11 +/- 0.05 m/s respectively) in regard to control group (0.18 +/- 0.07 m/s, p < 0.01). Pulsed Doppler tissue imaging was useful in the assessment of diastolic function in Chagas disease, including patients with no restrictive mitral and pulmonary vein filling pattern.

A total of 70 blood-donor volunteers were studied to determine the utility of the echocardiogram and Doppler in the diagnosis of cardiopathies in asymptomatic patients with Chagas disease. These patients came from endemic areas and had humoral positive reactions for South American Trypanosomiasis. They were checked against a control group of blood-donors with no environmental antecedents and with negative reactions. Both groups were similar in age and sex. The chagasic group showed an abnormal electrocardiogram in twelve cases (17.4%), being left anterior hemiblock the most frequent alteration found (nine cases, 62.5%). In the control group no alterations were found (p = 0.0005). The echocardiogram and Doppler were abnormal in 29 cases of the chagasic group (38.8%): alterations in ventricular relaxation were found in 8 cases (27.6%), enlargement of cavities in 9 (31%), both phenomena in 9 (31%) and alteration of parietal motility in 3 (10.3%). In the control group, 1 case presented alteration in ventricular relaxation (p = 0.000008). These results confirmed that the abnormal discoveries were related to Chagas disease. Out of 70 chagasic patients, 31 (44.29%) showed some alteration in the tests: 12 had an abnormal electrocardiogram, and of these only 2 had normal echocardiogram and Doppler, the rest showed abnormal echocardiogram and Doppler. Other 29 (of these 70 patients) showed some alteration in the echocardiogram and Doppler, and 20 of them presented a normal electrocardiogram. It can be concluded that the echocardiogram and Doppler are more accurate to detect cardiac involvement in asymptomatic chagasic patients than the electrocardiogram, showing abnormality in many cases where there are no electrocardiographic alterations. On the other hand, patients with abnormal electrocardiogram and Doppler are less frequent. Therefore, to define the undetermined period of Chagas disease echocardiogram and Doppler should be incorporated as a routine resource of diagnosis considering the high percentage of cases in which cardiac participation is detected when there is no clinic, radiologic and electrocardiographic disturbance.

The aim of the present study was to carry out a quantitative assessment of the regional left ventricular wall motion and diastolic function of patients with Chagas disease in different clinical stages. Twenty patients with positive immunofluorescence tests for Chagas disease were studied. Eight patients were asymptomatic (class I), 9 patients had electrocardiographic abnormalities (class II) and 3 patients had heart failure (class III). The control group consisted of 10 normal subjects. 2D echocardiographic images from parasternal and apical views were analysed quantitatively using a previously validated method for the assessment of the regional wall motion of the left ventricle. Diastolic flow velocities and times at mitral valve level were analysed using pulsed wave Doppler. Patients with Chagas disease showed marked wall motion abnormalities in the posterobasal segment compared with controls. These abnormalities were evident even in class I patients. The number of affected segments was higher in class II and class III. "A" wave velocity was greater in patients than in controls (0.67 +/- 0.17 and 0.49 +/- 0.08 m/s, p = 0.01 respectively) but the pattern of diastolic flow velocity was non specific. In conclusion, regional left ventricular wall motion abnormalities are common in early stages of Chagas disease suggesting that myocardial activity of the disease is present even during the asymptomatic period.

In order to establish whether different kinds of conduction disturbances like complete right branch block (CRBB) and left anterior hemiblock (LAH) are associated with different degrees of myocardial damage in Chagas disease (Chd), we studied 25 patients (p), 15 males and 10 women (41 +/- 5 years old) who were divided into five groups: normal EKG 5 p, incomplete right branch block 5 p, CRBB-LAH 5 p. We performed EKG, phonocardiogram, echo-M, 2-D and Doppler. The systolic function was evaluated with velocity of circumferential shortening and Weissler index; parietal motility with score of motility; dilatation with diastolic diameter of left ventricle and diastolic function with isovolumetric relaxation time and E/A ratio mitral and tricuspid. The patients who did not present basal severe arrhythmias were submitted to stress testing. We found that in LAH there were great systolic and diastolic dysfunctions, parietal motility alterations and malignant arrhythmias as compared with CRBB. There was no significant difference between LAH and CRBB-LAH. In Chagas disease, the presence of LAH showed much more myocardial damage than in CRBB.

With the purpose of analyzing diastolic function in Chagas, disease (ECh), 42 patients were studied: 31 males (aged 33 +/- 9), 22 of them with positive serology for ECh and 9 with negative serology; 11 female patients (aged 36 +/- 12), 10 with positive serology and 1 with negative serology. In all patients 2 D-Echo and simultaneous EKG, phonocardiogram, apexcardiogram and M-mode Echo at 100 mm/sec were taken. The A2-D, A2-O (total apexcardiographic relaxation-RAT), a/D (diastolic amplitude of "a" wave), ITRAT = A2 - C/RAT, DDVI, DSVI, shortening fraction (FA) and percentage of dimension changes (D D%) were determined. The patients were divided into 4 groups: G - A (n = 10) normal; G - B (n = 15) positive serology, with EKG and Rx and FA normal; G - C (n = 10) positive serology, abnormal EKG, and normal Rx and FA; G - D (n = 7) positive serology, abnormal EKG, mild cardiomegalia and diminished FA. The patients from group B presented significative modification, 46& (7/15) of the FD indexes and those from group D with 70% (5/7), as well as of D D C - E and D D Dm-0 indicative of uncoordinated contraction and relaxation. A progressive worsening of the FD from G - D was observed, reaching in this last one statistically significant values. In the ECh the alterations in the FD precede the systolic, which allows for an early detection of myocardiac damage by noninvasive techniques.