JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 1999; 33:522-529
© 1999 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Acquatella, H.
Right arrow Articles by Sánchez, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Acquatella, H.
Right arrow Articles by Sánchez, I.

CLINICAL STUDIES

Limited myocardial contractile reserve and chronotropic incompetence in patients with chronic Chagas’ disease

Assessment by dobutamine stress echocardiography

Harry Acquatella, MD, FACCa,b, Julio E. Pérez, MD, FACCa,b, Jose A. Condado, MDa,b and Indira Sánchez, Med Techa,b

a Centro de Investigaciones J.F. Torrealba, Hospital Universitario de Caracas, Centro Médico de Caracas, Caracas, Venezuela
b Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA

Manuscript received February 19, 1998; revised manuscript received August 31, 1998, accepted October 2, 1998.

Reprint requests and correspondence: Julio E. Pérez, MD, Director of Echocardiography, Washington University School of Medicine, 660 S Euclid Avenue, Box 8086, St. Louis, MO 63110-1093

Objectives

To determine whether dobutamine stimulation in patients with Chagas’ disease may uncover abnormal contractile responses as seen in ischemic myocardium.

Background

Segmental left ventricular (LV) dysfunction in the absence of coronary atherosclerosis is frequently seen in patients with chronic Chagas’ heart disease. Myocardial ischemia and coronary microcirculation abnormalities have been found in animal models and in humans with Chagas’ disease. In addition, chagasic sera may contain autoantibodies against human beta-adrenergic receptors.

Methods

Two groups of patients with Chagas’ disease were studied by echocardiography: group 1 (n = 12) without and group 2 (n = 14) with LV segmental wall motion abnormalities (mostly apical aneurysm). Ten normal subjects served as control subjects. We performed qualitative assessment of wall motion and quantitative evaluation of LV cavity under baseline conditions and after dobutamine stimulation.

Results

Patients with Chagas’ disease exhibited a blunted inotropic and chronotropic response to dobutamine stimulation. After dobutamine, fractional area change in Chagas’ group 1 (54.7 ± 6.6%; SD) and in group 2 (35.1 ± 12.1%) were significantly lower than control group (66.7 ± 2.5%; p < 0.001). In addition, in 6 of 14 group 2 patients, dobutamine induced a biphasic response with improvement at low dose and deterioration at peak dose, as seen in patients with coronary artery disease. Although the three groups had similar basal mean heart rates and attained a similar mean peak dobutamine doses, both groups of patients with Chagas’ disease had a significantly blunted mean heart rate effect after dobutamine (p < 0.0001).

Conclusions

Thus, dobutamine stimulation unmasks a chronotropic incompetence and a blunted myocardial contractile response in chagasic patients, even in those with no overt manifestation of heart disease.

Abbreviations and Acronyms
  ECG = electrocardiogram or electrocardiographic
  EDA = end-diastolic left ventricular cavity area
  ESA = end-systolic left ventricular cavity area
  HR = heart rate
  LV = left ventricle or left ventricular




This article has been cited by other articles:


Home page
CirculationHome page
H. Acquatella
Echocardiography in Chagas Heart Disease
Circulation, March 6, 2007; 115(9): 1124 - 1131.
[Abstract] [Full Text] [PDF]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 1999 by the American College of Cardiology Foundation.