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Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy

Gustavo J Volpe1, Henrique T Moreira1, Henrique S Trad1

  • 1Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil.

Journal of the American College of Cardiology
|November 24, 2018
PubMed

Insights

Myocardial fibrosis detected by late gadolinium enhancement (LGE) is common in chronic Chagas cardiomyopathy (CCC). This scar presence significantly predicts adverse cardiovascular events, including death and ventricular tachycardia, in CCC patients.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Fibrosis Research

Background:

  • Chronic Chagas cardiomyopathy (CCC) is characterized by significant myocardial fibrosis.
  • This fibrosis can increase the risk of sudden cardiac death, even with preserved left ventricular (LV) systolic function.
  • Cardiac magnetic resonance imaging (CMR) using late gadolinium enhancement (LGE) sequences can effectively visualize myocardial fibrosis.

Purpose of the Study:

  • To prospectively evaluate the predictive value of LGE-detected scar for hard adverse cardiovascular outcomes in a cohort of CCC patients.
  • To determine the association between myocardial scar and major adverse cardiac events in this population.

Main Methods:

  • A prospective cohort study included 140 patients with CCC.
  • Cardiac magnetic resonance (CMR) with cine and LGE imaging was performed at enrollment.
  • Primary endpoint: cardiovascular death and sustained ventricular tachycardia. Secondary endpoint: cardiovascular death, sustained ventricular tachycardia, or cardiovascular hospitalization.

Main Results:

  • Late gadolinium enhancement (LGE) scar was identified in 71.4% of patients, predominantly in the lateral, inferolateral, and inferior walls.
  • Patients with LGE scar exhibited poorer LV ejection fraction and higher LV end-diastolic volume and mass.
  • The presence of scar was significantly associated with higher rates for both primary (p=0.043) and secondary (p=0.016) endpoints.

Conclusions:

  • Myocardial scar, as detected by LGE, is a prevalent finding in patients with chronic Chagas cardiomyopathy.
  • The presence of LGE-detected scar is a strong independent predictor of major adverse cardiovascular outcomes in CCC.
  • CMR with LGE is a valuable tool for risk stratification in patients with CCC.
Abstract

Keywords:
ChagasChagas heart diseaseMRIclinical eventslate gadolinium enhancementscar

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