Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification

Abstract

BackgroundChagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score.MethodsThis study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score.ResultsRegarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76).ConclusionsCMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD.

A therapeutic vaccine prototype induces protective immunity and reduces cardiac fibrosis in a mouse model of chronic Trypanosoma cruzi infection

“…In this study, we show that a Tc24 recombinant protein vaccine with a stable emulsion containing E6020 as an immunomodulatory adjuvant results in a statistically significant reduction in cardiac fibrosis and inflammation in vaccinated mice compared to mice receiving the sham vaccination. This reduction in cardiac fibrosis is evidence of vaccine protection from chronic Chagas’ cardiomyopathy, as supported by studies that show the cardiac disease is characterized by inflammatory infiltrate and extensive reactive and reparative fibrosis [8, 35, 36]. Additionally, the Tc24+E6020-SE vaccine results in a reduction in detectable systemic parasitemia in vaccinated mice.…”

“…Chronic Chagas’ cardiomyopathy (CCC) clinically presents as conduction disorders and malignant arrhythmias, which can then progress to cardiomyopathy, heart failure, and even sudden cardiac death [7]. The disease is characterized histologically by post-inflammatory myocardial fibrosis [8], and human studies have shown that systemic parasite persistence is associated with disease severity [9, 10]. Clinical progression and survival are poorer in patients with CCC compared to patients with noninflammatory dilated cardiomyopathy, and myocardial fibrosis has been shown to be an independent predictor of adverse outcomes in CCC [11] [12].…”

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

“…Given the fact that cardioaortic embolic etiology showed a significant association with stroke recurrence, efforts directed toward identifying factors linked to this etiology must be considered, such as greater use of cardiac magnetic resonance and insertable cardiac monitors [35-36]. Interestingly, systolic dysfunction did not correlate with either recurrence or mortality, as would be expected in patients without IS, based on other data [32].…”

Cardiac Magnetic Resonance in the Assessment of Chagas Disease and its Complications

“…White et al, 33 demonstrated that the etiology of aborted sudden cardiac death or sustained monomorphic ventricular tachycardia was changed in 50% of the cases where patients were evaluated by CMR in comparison to conventional diagnostic investigation with transthoracic echocardiography and coronary angiography. 33 The use of MF in the prediction of adverse events in patients with CD was assessed by Uellendahl et al, 34 the authors correlated MF with prognostic data using the validated Rassi score, which identifies patients at risk (low, intermediate, or high) of dying prematurely. This correlation a and b, myocardial fibrosis in the circumflex artery territory (lateral wall -arrows).…”

“…evidenced a progressive increase in MF from low-to high-risk Rassi score groups and also confirmed a strong association among MF, cardiac dysfunction, and arrhythmia. 34 Recently, Senra et al, 35 identified MF in 76.1% of patients with chronic Chagas cardiomyopathy and defined a cutoff value for the myocardial fibrosis mass of 12.3 g for predicting the combined endpoint (all-cause mortality, heart transplantation, antitachycardia pacing or appropriate shock from an implantable cardioverter-defibrillator [ICD], and aborted sudden cardiac death). The study had an average follow-up of 5 years with an area under the curve of 0.79 (95% confidence interval [CI] 0.72−0.87).…”