Associations between Cardiac Magnetic Resonance T1 Mapping Parameters and Ventricular Arrhythmia in Patients with Chagas Disease

Abstract

Chronic Chagas disease can progress to myocardial involvement with intense fibrosis, which may predispose patients to sudden cardiac death through ventricular arrhythmia. The associations of myocardial fibrosis detected by cardiac magnetic resonance (CMR) parameters with non-sustained ventricular tachycardia (NSVT) were evaluated. This cross-sectional study included patients in early stages of Chagas disease (n = 47) and a control group (n = 15). Patients underwent cardiac evaluation, including CMR examination. Myocardial fibrosis assessment by CMR with measurement of late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) was performed.There was an increase in myocardial fibrosis CMR parameters and ventricular arrhythmias among different stages of Chagas disease, combined with a decrease in the left ventricular ejection fraction (LVEF) by CMR and also in the right ventricular systolic function by S' wave on tissue Doppler. Fibrosis mass and ECV were associated with the Rassi score, ventricular extrasystole, and E/e' ratio in a logistic regression model adjusted for age and gender. The ECV maintained an association with the presence of NSVT, even after adjustments for fibrosis mass and LVEF assessed by CMR. The receiver-operating characteristic area under the curve for global ECV (0.85; 95% CI: 0.71-0.99) and NSVT was greater than that for fibrosis mass (0.75; 95% CI: 0.54-0.96), although this difference was not statistically significant. Extracellular volume could be an early marker of increased risk of ventricular arrhythmia in Chagas disease, presenting an independent association with NSVT in the initial stages of chronic Chagas cardiomyopathy, even after adjustment for fibrosis mass and LVEF.

Untitled

“…The combined analysis of studies reporting delayed enhancement in patients with the indeterminate form shows the occurrence of myocardial scar in 19% of the pooled population (Table 1). 9,10,[32][33][34][35][36][37][38][39] Myocardial fibrosis progressively increases with disease progression, being considered a marker of CCDC severity. 9 The higher the proportion of delayed enhancement in relation to the LV mass, the lower the ejection fraction of this chamber and the worse the estimated functional class.…”

“…A crosssectional study of 47 Chagas patients demonstrated that higher interstitial fibrosis by its CMR-derived extracellular volume is associated with non-sustained ventricular tachycardia regardless of ejection fraction and delayed LV myocardial enhancement quantification. 38…”

Myocardial Involvement in Chagas Disease: From the Perspective of Cardiovascular Magnetic Ressonance Assessment

“…The combined analysis of studies reporting delayed enhancement in patients with the indeterminate form shows the occurrence of myocardial scar in 19% of the pooled population (Table 1). 9,10,[32][33][34][35][36][37][38][39] Myocardial fibrosis progressively increases with disease progression, being considered a marker of CCDC severity. 9 The higher the proportion of delayed enhancement in relation to the LV mass, the lower the ejection fraction of this chamber and the worse the estimated functional class.…”

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

“…Nevertheless, prognosis should not be entirely based on MF since there are other findings that CMR also identifies and are equally important to detect as early as possible on the disease’s natural history, including myocardial edema, aneurysm formation, intracavitary thrombus, and focal and diffuse fibrosis in the noted territories [ 84 , 85 , 86 , 87 ].…”