Cardiac magnetic resonance imaging in Chagas' disease: a parallel with electrophysiologic studies

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• Chagas' disease (CD), caused by Trypanosoma cruzi, is a major cause of cardiac disability in Central and South America.
• The disease progresses from an asymptomatic phase to symptomatic cardiac and gastro-intestinal issues, leading to chronic Chagas' myocarditis.
• Chronic Chagas' myocarditis involves myocardial fibrosis, chamber enlargement, and ventricular tachycardia (VT).

Purpose of the Study:

• To review patterns of myocardial fibrosis (MF) in chronic Chagas' disease (CHD).
• To correlate MF patterns with electrogram findings.
• To predict the risk of ventricular arrhythmias and sudden death in CD patients.

Main Methods:

• Cardiac magnetic resonance imaging (CMR) for characterizing myocardial fibrosis.
• Electrophysiology studies to analyze electrogram patterns.
• Review of existing literature on MF patterns and VT in CHD.

Main Results:

• Transmural scar is a common MF pattern in CHD, unlike sub-epicardial or mid-wall fibrosis.
• The left ventricular apex and basal infero-lateral wall are frequently affected by MF.
• Specific MF patterns correlate with electrogram findings, aiding in risk stratification.

Conclusions:

• Cardiac MRI is valuable for identifying MF patterns in Chagas' disease.
• Understanding MF distribution and electrophysiological characteristics can help predict VT risk.
• This knowledge can guide management strategies to prevent sudden cardiac death in CD patients.