Electro-Mechanical Dissociation in Chagas Cardiomyopathy: Comparative Analysis of Arrhythmic Burden Beyond LVEF.

BACKGROUND

Chronic Chagas cardiomyopathy (CCC) exhibits high arrhythmic risk despite preserved systolic function, challenging LVEF-based stratification.

METHODS

We performed a cross-sectional analysis of 146 heart failure patients (75 CCC, 71 Ischemic Cardiomyopathy [IC]) with comparable age, LVEF, and NT-proBNP.

RESULTS

CCC patients had a higher arrhythmic burden and NSVT prevalence (RR 4.37, 95% CI 1.67-11.39). NSVT prevalence in CCC was similar regardless of LVEF (p = 0.707). Conventional heart failure severity markers, including worse global and regional strain, were associated with NSVT in IC but not in CCC, where atrial fibrillation (p = 0.002) and ventricular aneurysms (p = 0.033) were the primary associated variables.

CONCLUSIONS

Arrhythmic vulnerability in CCC appears decoupled from LVEF, suggesting that complementary substrate-based markers may improve risk stratification in this population.