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[Magnetic resonance imaging in chronic Chagas cardiopathy. Correlation with endomyocardial biopsy findings]
R Kalil1, E A Bocchi, B M Ferreira
1Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo.
Insights
Magnetic resonance imaging (MRI) can help diagnose myocarditis in Chagas' heart disease by showing increased signal intensity in the heart after gadolinium contrast. This imaging technique shows promise for identifying inflammation in Chagas' patients.
Area of Science:
- Cardiology
- Medical Imaging
- Infectious Diseases
Background:
- Chagas' heart disease is a chronic condition often leading to heart failure.
- Diagnosing active myocarditis in Chagas' disease can be challenging.
- Endomyocardial biopsy is invasive and may not always reflect diffuse myocardial involvement.
Purpose of the Study:
- To investigate the correlation between cardiac magnetic resonance imaging (CMR) findings and right ventricle endomyocardial biopsy (RVEMB) results in patients with chronic Chagas' heart disease.
- To assess the utility of CMR with gadolinium enhancement in detecting myocardial inflammation in Chagas' heart disease.
Main Methods:
- Ten male patients with Chagas' heart disease (mean age 47) in New York Heart Association functional classes II-IV underwent RVEMB and CMR.
- A control group of patients with idiopathic dilated cardiomyopathy (mean age 46) was also studied for comparison.
- Septal signal intensity on CMR after gadolinium contrast administration was quantitatively analyzed.
Main Results:
- All Chagas' disease patients showed increased myocardial signal intensity on CMR after gadolinium, with significant septal signal change (0.87 to 1.54, p < 0.001).
- RVEMB confirmed myocarditis in eight Chagas' patients and borderline myocarditis in two.
- The control group showed no significant change in septal signal intensity after gadolinium (0.93 to 0.89, p = ns), with only one borderline myocarditis diagnosis.
Conclusions:
- Myocarditis is a common finding in Chagas' heart disease.
- Patients with Chagas' heart disease exhibit a significant increase in myocardial signal intensity post-gadolinium on CMR compared to controls.
- Cardiac MRI appears to be a promising, non-invasive tool for diagnosing active inflammation in Chagas' heart disease.
Purpose:
To study the correlation between magnetic resonance imaging of the heart and right ventricle endomyocardial biopsy results in chronic Chagas' heart disease.
Methods:
Ten patients with Chagas' disease, mean age 47 +/- 7 years, all males, in congestive heart failure with New York Heart Association class II (2 patients), III (6) and IV (2) were studied. Mean left ventricular ejection fraction was at echocardiogram 36 +/- 6%. The patients were submitted to right ventricular endomyocardial biopsy and magnetic resonance imaging of the heart. The results of this group were compared with a control group of patients with idiopathic dilated cardiomyopathy, with mean age of 46 +/- 10 years and left ventricular ejection fraction of 30 +/- 4%, in heart failure with functional class II (1 patient), III (5) and IV (1).
Results:
All patients with Chagas' heart disease presented an increase in magnetic ressonance imaging signal of the heart after gadolinium use. The septal signal intensity changed from 0.87 +/- 0.06 to 1.54 +/- 0.16 (p < 0.001). In the control group the mean septal signal intensity was 0.93 +/- 0.07 before and 0.89 +/- 0.06 after the gadolinium (p = ns). Eight patients of the Chagas' disease group had biopsy proven myocarditis and two had borderline myocarditis. However, only one patient of the control group had diagnosis of borderline myocarditis.
Conclusion:
Myocarditis is frequently found in Chagas' heart disease patients and who unlike controls present a significant increase in myocardial signal intensity after gadolinium infusion. The magnetic resonance imaging of the heart seems a promising alternative method for the diagnosis of an inflammatory process in Chagas' heart disease.