{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:18:28Z","timestamp":1791649108502,"version":"4.3.4"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,9,15]],"date-time":"2013-09-15T00:00:00Z","timestamp":1379203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies suggest that microvascular abnormalities may contribute to the pathogenesis of Chagas\u2019 heart disease. Coronary flow reserve (<jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>) 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 <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content> in patients with indeterminate form of Chagas\u2019 disease, and also to identify the determinants of <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixty\u2010four asymptomatic patients (37% male; age 49.9\u00a0\u00b1\u00a011.5\u00a0years) with normal cardiovascular exams classified as in indeterminate form of Chagas\u2019 disease underwent transthoracic dipyridamole (0.84\u00a0mg\/kg in 6\u00a0min) stress echocardiography, and were compared with a control group of healthy patients. Coronary flow reserve was assessed on left anterior descending artery using pulsed <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>oppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. A treadmill exercise test was performed to rule out ischemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients had good functional capacity assessed by exercise testing with peak oxygen consumption (VO<jats:sub>2<\/jats:sub>) of 28\u00a0\u00b1\u00a011\u00a0mL\/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\u2019 disease patients than those in healthy individuals (1.9\u00a0\u00b1\u00a00.4 vs. 2.6\u00a0\u00b1\u00a00.5; P\u00a0&lt;\u00a00.001). Several factors were correlated with the <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>, including age, ejection fraction, left ventricular diastolic function, heart rate recovery, and the presence of Chagas\u2019 disease. In a multivariate analysis, age and positive serology for Chagas\u2019 disease were independent factors associated with the <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Coronary flow reserve was impaired in Chagas\u2019 disease patients in the indeterminate form compared with healthy individuals with similar clinical features. Among all variables tested, age and positive serology for Chagas\u2019 disease were independent factors associated with the <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.12364","type":"journal-article","created":{"date-parts":[[2013,10,8]],"date-time":"2013-10-08T16:35:56Z","timestamp":1381250156000},"page":"67-73","source":"Crossref","is-referenced-by-count":17,"title":["Impaired Coronary Flow Reserve in Patients with Indeterminate Form of Chagas\u2019 Disease"],"prefix":"10.1111","volume":"31","author":[{"given":"Daniel R.","family":"Rabelo","sequence":"first","affiliation":[{"name":"Post\u2010Graduate Program in Infectious Diseases and Tropical Medicine School of Medicine Federal University of Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoel Ot\u00e1vio da Costa","family":"Rocha","sequence":"additional","affiliation":[{"name":"Post\u2010Graduate Program in Infectious Diseases and Tropical Medicine School of Medicine Federal University of Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rcio V. L.","family":"de Barros","sequence":"additional","affiliation":[{"name":"Post\u2010Graduate Program in Infectious Diseases and Tropical Medicine School of Medicine Federal University of Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luiz Padilha da","family":"Silva","sequence":"additional","affiliation":[{"name":"Statistical Department Federal University of Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy C.","family":"Tan","sequence":"additional","affiliation":[{"name":"Cardiac Ultrasound Lab Massachusetts General Hospital Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria C. P.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Post\u2010Graduate Program in Infectious Diseases and Tropical Medicine School of Medicine Federal University of Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60061-X"},{"key":"e_1_2_6_3_1","volume-title":"Estimacion Cuantitativa de la Enfermedad de Chagas en las Americas [in Spanish]","author":"Organizacion Panamericana de La Salud","year":"2006"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1516-31801995000200010"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0037-86821998000300008"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762009000900022"},{"key":"e_1_2_6_7_1","first-page":"464","article-title":"The involvement of coronary microvasculature in cardiomyopathies","volume":"13","author":"Bestetti RB","year":"2003","journal-title":"Rev. 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