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Updated: Aug 24, 2025
3D Whole-heart Myocardial Tissue Analysis
Published on: April 12, 2017
Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac
João Bosco de Figueiredo Santos1, Ilan Gottlieb2, Eduardo Marinho Tassi3
1Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil.
Insights
Border zone channel extension in Chagas heart disease patients, identified by cardiac MRI, independently predicts clinical events like mortality or defibrillator implantation.
Area of Science:
- Cardiology
- Medical Imaging
- Pathophysiology
Background:
- Chagas heart disease leads to myocardial scarring.
- The border zone of viable myocardium surrounding scar is poorly understood.
- This region may influence clinical events.
Purpose of the Study:
- To describe border zone morphology in Chagas heart disease.
- To assess the association between border zone characteristics and clinical outcomes.
Main Methods:
- 22 adult Chagas heart disease patients underwent contrast-enhanced cardiac MRI.
- Myocardial delayed enhancement identified scar, border zone channels (number, mass, length).
- Cox regression analyzed association between border zone parameters and clinical events (mortality/ICD).
Main Results:
- 44 border zone channels were identified (1-3 per patient).
- Border zone channel extension was associated with clinical events, independent of ejection fraction or fibrosis mass.
- Channel extension (2.4 layers) predicted adverse outcomes.
Conclusions:
- High-resolution cardiac MRI effectively visualizes border zone channels in Chagas heart disease.
- Border zone channel extension is an independent predictor of clinical events in these patients.
Background:
We aimed to describe the morphology of the border zone of viable myocardium surrounded by scarring in patients with Chagas heart disease and study their association with clinical events.
Methods:
Adult patients with Chagas heart disease (n=22; 55% females; 65.5 years, SD 10.1) were included. Patients underwent high-resolution contrast-enhanced cardiac magnetic resonance using myocardial delayed enhancement with postprocessing analysis to identify the core scar area and border zone channels number, mass, and length. The association between border zone channel parameters and the combined end-point (cardiovascular mortality or internal cardiac defibrillator implantation) was tested by multivariable Cox proportional hazard regression analyses. The significance level was set at 0.05. Data are presented as the mean (standard deviation [SD]) or median (interquartile range).
Results:
A total of 44 border zone channels (1[1-3] per patient) were identified. The border zone channel mass per patient was 1.25 (0.48-4.39) g, and the extension in layers of the border zone channels per patient was 2.4 (1.0-4.25). Most border zone channels were identified in the midwall location. Six patients presented the studied end-point during a mean follow-up of 4.9 years (SD 1.6). Border zone channel extension in layers was associated with the studied end-point independent from left ventricular ejection fraction or fibrosis mass (HR=2.03; 95% CI 1.15-3.60).
Conclusions:
High-resolution contrast-enhanced cardiac magnetic resonance can identify border zone channels in patients with Chagas heart disease. Moreover, border zone channel extension was independently associated with clinical events.
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