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Radionuclide evaluation of left-ventricular function in chronic Chagas' cardiomyopathy
Insights
Chronic Chagas' disease significantly impacts heart function, causing reduced left-ventricular ejection fraction (LVEF) and regional wall motion abnormalities (WMA). These cardiac issues progress with disease severity, affecting up to 75% of patients with heart failure.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Chronic Chagas' disease, caused by Trypanosoma cruzi, is a significant cause of heart disease in endemic areas.
- Cardiac involvement in Chagas' disease can lead to progressive heart failure and arrhythmias.
- Understanding the specific patterns of cardiac dysfunction is crucial for patient management.
Purpose of the Study:
- To assess left-ventricular ejection fraction (LVEF) and regional wall motion abnormalities (WMA) in patients with chronic Chagas' disease using radionuclide ventriculography.
- To correlate cardiac dysfunction with clinical presentation (asymptomatic, arrhythmic, congestive heart failure).
- To compare radionuclide ventriculography findings with contrast ventriculography and evaluate coronary arteries.
Main Methods:
- Prospective study of 41 patients with chronic Chagas' disease.
- Radionuclide ventriculography to measure LVEF and assess regional WMA.
- Clinical classification into asymptomatic (ASY), arrhythmic (ARR), and congestive heart failure (CHF) groups.
- Correlation analysis with contrast ventriculography and selective coronary arteriography.
Main Results:
- Mean LVEF was normal in ASY patients but significantly depressed in CHF patients.
- Regional WMAs were minimal in ASY, increased in ARR, and prevalent in CHF (75% with diffuse hypokinesia).
- The infero-apical region was most frequently affected (63%); 7 patients had apical aneurysms. Coronary arteries were normal in all patients.
Conclusions:
- Chronic Chagas' heart disease causes significant left ventricular dysfunction and regional wall motion abnormalities.
- The severity of LVEF reduction and WMA correlates with clinical progression from asymptomatic to heart failure.
- Radionuclide ventriculography is a reliable method for assessing cardiac involvement in Chagas' disease, which should be considered alongside ischemic heart disease as a cause of WMA.
Abstract:
Left-ventricular ejection fraction (LVEF) and abnormalities of regional wall motion (WMA) were studied by means of radionuclide ventriculography in 41 patients prospectively diagnosed as having chronic Chagas' disease. Thirteen patients were asymptomatic (ASY), 16 were arrhythmic (ARR), and 12 had congestive heart failure (CHF). Mean LVEF was normal in ASY (0.64 +/- 0.06) but markedly depressed in CHF (0.28 +/- 0.08). Regional WMAs were minimal in ASY and their severity increased in ARR. Most CHFs (75%) had diffuse hypokinesia of the left ventricle. The region most frequently affected was the infero-apical (63%). Seven patients had a distinct apical aneurysm. Correlation between radionuclide and contrast ventriculography data was good in 17 patients. For LVEF, r = 0.90. For WMA there was agreement between the two techniques in 77% of 65 segments compared. Best agreement occurred with infero-apical lesions (88%), and worst with septal (69%). Selective coronary arteriography showed normal arteries in all patients. Therefore, chronic Chagas' heart disease joins ischemic heart disease as a cause of regional WMA.