Cardiac Magnetic Resonance in Chagas' Disease

Abstract

American trypanosomiasis (Chagas' disease [CD]) caused by Trypanosoma cruzi is endemic in Latin America, where it is one of the leading causes of death. The involvement of the heart is crucial in the patients' prognosis. Besides lymphocytic myocarditis, cardiomyopathy is associated with several degrees of myocardial fibrosis (MF). Myocardial delayed enhancement by cardiac magnetic resonance (CMR) has been considered the most accurate method to detect MF in ischemic and nonischemic cardiomyopathy, including Chagas' heart disease. Additionally, CMR offers a wide variety of imaging tools to evaluate in detail morphology, the function and other tissue characterization abilities, such as detection of edema and fat. The present article aims to discuss the current clinical applicability of CMR to evaluate CD. We also discuss its future as a screening tool for very early myocardial involvement, which would allow the investigation of new therapeutic methods with potential influence in the natural history of CD.

Prevalência e valor prognóstico da dissincronia ventricular na cardiomiopatia chagásica

“…When analyzing the precision of dyssynchrony measurements, we can see a lower intraobserver variability, when compared with the interobserver one. These reflect, in a certain way, the high variability of these values that have been previously reported in the literature [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . The recently published study PROSPECT showed a low predictive value of the echocardiogram in relation to dyssynchrony.…”

“…Possible explanations for this higher prevalence in chagasic patients would be the segmental alterations secondary to areas of fibrosis associated with the chronic, diffuse inflammatory process, which is persistent and inherent to this disease 15,16 .…”

Magnetic Resonance Imaging of the Myocardium, Coronary Arteries, and Anomalous Origin of Coronary Arteries

“…Any associated thrombus can also be easily detected by CMRI [ 233 ]. The LV apex (located at the terminal circulation of the left anterior descending [LAD] and right coronary artery [RCA]) and the basal inferolateral wall (located at the terminal circulation of the left circumfl ex artery and the RCA) are postulated to be the preferential sites of aneurysmal dilation because they may be especially prone to repeated ischemic insults due to chronic myocardial infl ammation as various infl ammatory mediators and cytokines are released [ 233 ].…”

The Substrate and Ablation of Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy

“…78 Histologic examination reveals inflammatory infiltrates, variable degrees of cellular damage and marked reparative fibrosis. 79, 80 Fibrosis is distributed predominantly in the epicardium. 44 Surviving myocardial fibers can be observed distributed in a random fashion within the areas of fibrosis.…”