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Impaired coronary flow reserve in patients with indeterminate form of Chagas' disease.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Rabelo, Daniel R. Rocha, Manoel Otávio da Costa de Barros, Márcio V. L. Silva, José Luiz Padilha da Tan, Timothy C. Nunes, Maria C. P.
Description	Country affiliation: Brazil Author Affiliation: Rabelo DR ( Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.)
Abstract	BACKGROUND: Previous studies suggest that microvascular abnormalities may contribute to the pathogenesis of Chagas' heart disease. Coronary flow reserve (CFR) expressed by the maximum achievable flow relative to baseline flow in the coronary microcirculation, may be useful in identifying patients who may be developing cardiac manifestations of the disease. This study aims to assess the CFR in patients with indeterminate form of Chagas' disease, and also to identify the determinants of CFR. METHODS: Sixty-four asymptomatic patients (37% male; age 49.9 ± 11.5 years) with normal cardiovascular exams classified as in indeterminate form of Chagas' disease underwent transthoracic dipyridamole (0.84 mg/kg in 6 min) stress echocardiography, and were compared with a control group of healthy patients. Coronary flow reserve was assessed on left anterior descending artery using pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. A treadmill exercise test was performed to rule out ischemia. RESULTS: All patients had good functional capacity assessed by exercise testing with peak oxygen consumption (VO2 ) of 28 ± 11 mL/kg per minute, similar to the controls. There were no differences in the echocardiographic parameters of diastolic and systolic left ventricular function and right ventricular function between the patients and controls. Coronary flow reserve was significantly lower in Chagas' disease patients than those in healthy individuals (1.9 ± 0.4 vs. 2.6 ± 0.5; P < 0.001). Several factors were correlated with the CFR, including age, ejection fraction, left ventricular diastolic function, heart rate recovery, and the presence of Chagas' disease. In a multivariate analysis, age and positive serology for Chagas' disease were independent factors associated with the CFR. CONCLUSIONS: Coronary flow reserve was impaired in Chagas' disease patients in the indeterminate form compared with healthy individuals with similar clinical features. Among all variables tested, age and positive serology for Chagas' disease were independent factors associated with the CFR.
File Format	HTM / HTML
ISSN	07422822
Issue Number	1
Volume Number	31
e-ISSN	15408175
Journal	Echocardiography
Language	English
Publisher	Wiley
Publisher Date	2014-01-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Coronary Circulation Research Support, Non-u.s. Gov't Sensitivity And Specificity Complications Humans Middle Aged Male Echocardiography, Stress Coronary Artery Disease Image Interpretation, Computer-assisted Journal Article Physiopathology Chagas Disease Reproducibility Of Results Fractional Flow Reserve, Myocardial Etiology Discipline Cardiology Blood Flow Velocity Echocardiography, Doppler Female Methods
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine

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