BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR. (PCR . (CD) clinical electrocardiographic T singlecentre single centre crosssectional cross sectional analysis 005 0 05 0.0 significant 33 56.4% 564 56 4 (56.4 men 6 1 years, years , years) 411 41 41.1% odds OR (OR 053 53 0.5 95% 95 [95 (CI 0.300.93 030093 0.30 0.93 30 93 0.30-0.93] 0.03, 003 0.03 03 0.03} 178 78 1.7 (95 1.092.89 109289 1.09 2.89 09 2 89 1.09-2.89) 0.02, 002 0.02 02 0.02] 013 13 0.1 0.040.38 004038 0.04 0.38 04 38 0.04-0.38) 0.0002. 00002 0.0002 0002 0.0002] n 39, 39 39) 10% (10% parameters (CD 00 0. 3 56.4 5 (56. 41.1 9 [9 300 0.300.9 03009 030 0.3 093 0.9 0.30-0.93 17 7 1. (9 092 1.092.8 10928 109 1.0 289 2.8 8 1.09-2.89 01 040 0.040.3 00403 004 038 0.04-0.38 0000 0.000 000 (10 56. (56 41. [ 0.300. 0300 0.30-0.9 ( 1.092. 1092 28 2. 1.09-2.8 0.040. 0040 0.04-0.3 0.00 (1 (5 0.300 0.30-0. 1.092 1.09-2. 0.040 0.04-0. 0.30-0 1.09-2 0.04-0 0.30- 1.09- 0.04-

Resumo Fundamentos: Novas técnicas ecocardiográficas são utilizadas no diagnóstico e prognóstico de diversas cardiopatias. No entanto, muitos desses novos índices ainda carecem de valores de referência em diferentes populações. Estudamos esses novos parâmetros ecocardiográficos em um grupo de brasileiros sem doença cardiovascular conhecida. Objetivo: Estudar valores dos novos índices ecocardiográficos em brasileiros sem doença cardiovascular conhecida e sua correlação com a idade. Métodos: Estudo transversal composto por indivíduos saudáveis que realizaram ecocardiograma tridimensional (E3D) e ecocardiograma bidimensional com análise de deformação (e) por speckle tracking (EST). Foram analisadas as funções atrial esquerda (AE) e ventricular esquerda (VE) por E3D e EST, e a função ventricular direita (VD) por EST. Valores de p < 0,05 foram considerados significantes. Resultados: Foram incluídos setenta e sete indivíduos (46,7% homens; 40,4 ± 10,4 anos). Os volumes AE máximo, mínimo e pré-contração atrial (pré-A) (ml/m2) foram 21,2 ± 5,5, 7,8 ± 2,5 e 11,0 ± 3,1, respectivamente. O pico da e global positiva do AE (LAScd), pico da e global negativa do AE e e global total do AE (LASr) foram 17,4±5,2%, -13,2 ± 2,0% e 30,5 ± 5,9%, respectivamente. Os volumes diastólico final e sistólico final do VE (ml/m2) mediram 57 ± 12 e 24 ± 6 e a fração de ejeção tridimensional do VE mediu 58 ± 6%. A e longitudinal, circunferencial e radial global do VE foi de -19 ± 2%, -19 ± 3% e 46 ± 12%, respectivamente. A torção do VE mediu 1,6 ± 0,7(0)/cm. A e longitudinal global do VD (SLG-VD) e a deformação da parede livre do VD foram de -22 ± 3% e -24 ± 5%. Os volumes mínimo e pré-A do AE, rotação apical do VE, torção e SLG-VD aumentaram com a idade, enquanto as frações de esvaziamento total e passivo do LA, LAScd, LASr, volumes diastólico final e sistólico final do VE diminuíram com a idade. Conclusão: Apresentam-se os valores para os novos índices ecocardiográficos em brasileiros sem doença cardiovascular conhecida e sua correlação com a idade.

Abstract Background: New echocardiographic techniques are used in the diagnosis and prognosis of many heart diseases. However, reference values in different populations are still needed for several of these new indexes. We studied these new echocardiographic parameters in a group of Brazilians with no known cardiovascular disease. Objective: To study values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age. Methods: Cross-sectional study that included healthy individuals who underwent three-dimensional echocardiography (3DE) and two-dimensional speckle tracking echocardiography (STE) strain (e) analysis. Left atrial (LA) and left ventricular (LV) function were analyzed by 3DE and STE, and right ventricular (RV) function by STE. P values < 0.05 were considered significant. Results: Seventy-seven subjects (46.7% men; 40.4 ± 10.4 years) were included. Maximum, minimum and pre-atrial contraction (pre-A) LA volumes (ml/m2) were 21.2 ± 5.5, 7.8 ± 2.5, and 11.0 ± 3.1, respectively. Peak positive global LA e (LAScd), peak negative global LA e and total global LA e (LASr) were 17.4 ± 5.2%, -13.2 ± 2.0% and 30.5 ± 5.9%, respectively. LV end-diastolic and end-systolic volumes (ml/m2) measured 57 ± 12 and 24 ± 6, and 3D LV ejection fraction measured 58 ± 6%. Global LV longitudinal, circumferential and radial e were -19 ± 2%, -19 ± 3%, and 46 ± 12%, respectively. LV torsion measured 1.6 ± 0.70 /cm. Global longitudinal RV e (RV-GLS) and RV free wall strain were -22 ± 3% and -24 ± 5%. Minimum LA and pre-A volumes, LV apical rotation, torsion and RV-GLS increased with age, while total and passive LA emptying fractions, LAScd, LASr, LV end-diastolic and end-systolic volumes decreased with age. Conclusion: Values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age are presented.

BACKGROUND Transforming growth factor β1 (TGF-β1) and tumour necrosis factor (TNF) have been implicated in Chagas disease pathophysiology and may correlate with left ventricular (LV) function. OBJECTIVES We determined whether TGF-β1 and TNF serum levels correlate with LV systolic and diastolic functions and brain natriuretic peptide (BNP) serum levels in chronic Chagas disease. METHODS This cross-sectional study included 152 patients with Chagas disease (43% men; 57 ± 12 years old), classified as 53 patients with indeterminate form and 99 patients with cardiac form (stage A: 24, stage B: 25, stage C: 44, stage D: 6). TGF-β1, TNF, and BNP were determined by enzyme-linked immunosorbent assay ELISA. Echocardiogram was used to determine left atrial and LV diameters, as well as LV ejection fraction and diastolic function. FINDINGS TGF-b1 serum levels were lower in stages B, C, and D, while TNF serum levels were higher in stages C and D of the cardiac form. TGF-β1 presented a weak correlation with LV diastolic function and LV ejection fraction. TNF presented a weak correlation with left atrial and LV diameters and LV ejection fraction. CONCLUSIONS TNF is increased, while TGF-β1 is decreased in the cardiac form of chronic Chagas disease. TNF and TGF-β1 serum levels present a weak correlation with LV systolic and diastolic function in Chagas disease patients.

OBJETIVO: A relação temporal entre disfunção ventricular (DV) após infarto do miocárdio (IM) e função mecânica do miocárdio remanescente não está estabelecida. O trabalho analisou, por ecodopplercardiograma (ECO), a função ventricular de ratos com IM de grandes dimensões e a função mecânica de músculos papilares (MP) no término do período de cicatrização. MÉTODOS: Estudados ECO e MP de 9 ratos Wistar (IM), três semanas após IM e 9 controles (C). Determinaram-se: tensão desenvolvida (TD) e sua primeira derivada positiva e negativa, tempo de pico de tensão, tensão de repouso e tempo de relaxamento a 50% de TD em concentrações de cálcio (em mM) de 0,5, 1,0, 1,5, 2,0 e 2,5. Após rianodina, foram promovidas contrações tetânicas em concentrações de cálcio de 1,5, 2,5 e 5,0. RESULTADOS: O ECO caracterizou DV com marcada anormalidade do volume diastólico e da fração de ejeção do VE, além de nítido padrão restritivo do fluxo sangüíneo pela valva mitral. Não foi identificada diferença significante entre os dados de mecânica miocárdica dos ratos IM e C. CONCLUSÃO: A insuficiência cardíaca (IC) que ocorre em ratos com IM > 40% do VE, no final do período de cicatrização, não depende de disfunção miocárdica. As modificações estruturais da câmara e a menor população de miócitos devem fundamentar a DV e a IC.

OBJECTIVE: The temporal relation between ventricular dysfunction (VD) after myocardial infarction (MI) and remanent myocardium mechanics is not yet clear. The present work investigated - through Doppler echocardiography (ECHO) - ventricular function in rats with extensive MI, as well as the mechanical function of papillary muscles (PM) at the end of the healing period. METHODS: ECHO and PM of 9 Wistar rats (MI) were studied against 9 controls (C) three weeks after LV myocardial infarction. The following were determined: developed tension (DT) and its first negative and positive derivative, time-to-peak tension (TPT), resting tension (RT), and relaxation time at 50% of DT at 0.5, 1.0, 1.5, 2.0 and 2.5 calcium concentrations (mM). Tetanic contractions were carried out after ryanodine administration at 1.5, 2.5 and 5.0 calcium concentrations. RESULTS: VD was characterized by ECHO, with marked abnormality of diastolic volume and LV and ejection fraction in addition to clear restrictive pattern of blood flow through the mitral valve. No significant difference was found in myocardial mechanics data either for MI or for C rats. CONCLUSION: The heart failure (HF) reported by MI rats with > 40% MI at the end of the healing period is not myocardial function dependent. Chamber structural changes and lower population of myocites should base VD and HF.