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Myocardial tissue characterization in Chagas' heart disease by cardiovascular magnetic resonance
Jorge A Torreão1,2, Barbara M Ianni3, Charles Mady4
1Heart Institute, InCor, University of Sao Paulo Medical School,Cardiovascular Magnetic Resonance andComputed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. jatorreao@hotmail.com.
Insights
Cardiovascular magnetic resonance (CMR) can detect myocardial edema and hyperemia in all phases of Chagas' heart disease, correlating with fibrosis and clinical severity. These findings may aid in understanding disease progression and patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Parasitology
Background:
- Chagas' heart disease is a significant public health concern in South America, with pathogenesis in subclinical stages remaining unclear.
- Pathologically, it involves chronic myocardial inflammation and fibrosis, detectable via late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR).
- This study investigates CMR surrogates for fibrosis, edema, and hyperemia across different clinical phases of the disease.
Purpose of the Study:
- To investigate the presence of late gadolinium enhancement (LGE), T2-weighted (T2W) signal intensity, and T1-weighted myocardial early gadolinium enhancement (MEGE) in patients with Chagas' heart disease.
- To evaluate these CMR findings across the indeterminate, cardiac non-dyssynergic, and cardiac dyssynergic phases.
- To correlate CMR findings with myocardial fibrosis, edema, hyperemia, and clinical severity.
Main Methods:
- Analysis of 54 patients with Chagas' heart disease across three clinical phases: indeterminate (IND), cardiac phase with no left ventricular systolic dysfunction (CPND), and cardiac phase with left ventricular systolic dysfunction (CPD).
- All patients underwent a 1.5 T CMR scan.
- CMR sequences included LGE, T2W, and MEGE to assess myocardial abnormalities.
Main Results:
- Late gadolinium enhancement (LGE) was observed in 72.2% of all patients, significantly increasing from IND (12.5%) to CPND (94.1%) and CPD (100%).
- Myocardial edema (T2W) and hyperemia (MEGE) were also prevalent (77.8% and 73.8% respectively), showing similar trends across disease phases.
- A strong correlation was found between LGE and T2W findings (r=0.72, p<0.001).
Conclusions:
- CMR-detected myocardial edema (T2W) and hyperemia (MEGE) are present in all Chagas' heart disease phases, including subclinical (IND).
- These findings parallel myocardial fibrosis (LGE) in extent and location, correlating with clinical severity.
- These CMR markers enhance understanding of Chagas' heart disease pathophysiology and may offer future prognostic and therapeutic value.
Background:
Chagas' heart disease is an important public health problem in South America. Several aspects of the pathogenesis are not fully understood, especially in its subclinical phases. On pathology Chagas' heart disease is characterized by chronic myocardial inflammation and extensive myocardial fibrosis. The latter has also been demonstrated by late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). In three clinical phases of this disease, we sought to investigate the presence of LGE, myocardial increase in signal intensity in T2-weighted images (T2W) and in T1-weighted myocardial early gadolinium enhancement (MEGE), previously described CMR surrogates for myocardial fibrosis, myocardial edema and hyperemia, respectively.
Methods:
Fifty-four patients were analyzed. Sixteen patients with the indeterminate phase (IND), seventeen patients with the cardiac phase with no left ventricular systolic dysfunction (CPND), and twenty-one patients with the cardiac phase with left ventricular systolic dysfunction (CPD). All patients underwent 1.5 T CMR scan including LGE, T2W and MEGE image sequences to evaluate myocardial abnormalities.
Results:
Late gadolinium enhancement was present in 72.2 % of all patients, in 12.5 % of IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). Myocardial increase in signal intensity in T2-weighted images (T2W) was present in 77.8 % of all patients, in 31.3 % of the IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). T1-weighted myocardial early gadolinium enhancement (MEGE) was present in 73.8 % of all patients, in 25.0 % of the IND, 92.3 % of the CPND and 94.1 % of the CPD (p < 0.0001). A good correlation between LGE and T2W was observed (r = 0.72, and p < 0.001).
Conclusions:
Increase in T2-weighted (T2W) myocardial signal intensity and T1-weighted myocardial early gadolinium enhancement (MEGE) can be detected by CMR in patients throughout all phases of Chagas' heart disease, including its subclinical presentation (IND). Moreover, those findings were parallel to myocardial fibrosis (LGE) in extent and location and also correlated with the degree of Chagas' heart disease clinical severity. These findings contribute to further the knowledge on pathophysiology of Chagas' heart disease, and might have therapeutic and prognostic usefulness in the future.
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