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Heart aneurysm in Chagas' disease
1Department of Pathology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. jamdoliv@fmrp.usp.br
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This study investigated the apical lesion in Chagas' disease, suggesting an ischemic factor in its development. Hearts with aneurysms showed significantly higher scores, indicating reduced myocardial irrigation.
Area of Science:
- Cardiology
- Pathology
- Chagas' Disease Research
Background:
- The pathogenesis of the apical lesion in Chagas' disease remains unclear.
- Previous studies did not establish a link between lesion frequency and heart weight, suggesting vascular factors were not primary.
Purpose of the Study:
- To evaluate relative coronary insufficiency as a potential factor in apical lesion development.
- To establish a more sensitive morphological assessment of myocardial ischemia in Chagas' cardiopathy.
Main Methods:
- Prospective study of 41 autopsy-collected human hearts.
- Injected colored gels into coronary arteries to map vascular beds.
- Calculated Right Ventricle/Left Ventricle (RV/LV) mass ratio and Right Coronary Artery/Ventricular Weight (RC/VW) mass ratio.
- Developed a composite score correlating with myocardial irrigation.
Main Results:
- A score was developed to assess myocardial irrigation.
- A rightward deviation in lesion frequency was observed when plotted against the score.
- Hearts with apical aneurysms exhibited significantly higher ischemia scores.
Conclusions:
- Suggests a significant ischemic factor in the pathogenesis of the apical lesion in Chagas' cardiopathy.
- The developed scoring system offers a more sensitive morphological evaluation of relative ischemia.
Abstract:
This prospective study on 41 autopsy collected human hearts concerns the "apical" lesion in Chagas' disease. Previous report did not show a correlation between lesion frequency and heart weight then discarding a vascular factor in its pathogenesis. The present paper involves other variables besides the heart weight to evaluate the relative coronary insufficiency. Distinct colored gel (green and red) injected through the capillary beds of both coronary arteries defined the extent of both vessels before separating the atria and removing the sub-epicardium fat. The Right Ventricle (RV) and Left Ventricle (LV) free walls furnished the RV/LV mass ratio. The myocardium mass colored green (right coronary artery--RC) and the whole Ventricular Weight (VW) determined the RC/VW mass ratio. The heart weight plus these mass ratios, graded and added, composed a score inversely proportional to the myocardium irrigation condition. It intended to be a more sensitive morphologic evaluation of the relative ischaemia to correlate to the apical lesion. This study showed a right deviation for the relative accumulated frequency of lesions plotted as a score function and a significant difference for higher scores in hearts with aneurysm. It suggests a ischaemic factor intervening in the apical lesion pathogenesis in Chagas' cardiopathy.