Evaluation of Right Ventricular Systolic Function in Chagas Disease Using Cardiac Magnetic Resonance Imaging

Moreira, Henrique T.; Volpe, Gustavo Jardim; Marin-Neto, José Antônio; Ambale-Venkatesh, Bharath; Nwabuo, Chike C.; Trad, Henrique Simão; Romano, Minna Moreira Dias; Pazin‐Filho, Antônio; Maciel, Benedito Carlos; Lima, João A.C.; Schmidt, André

doi:10.1161/circimaging.116.005571

Cited by 22 publications

(17 citation statements)

References 28 publications

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“…However, the incremental value of CMR to other traditional imaging modalities in structural and functional evaluation of the right ventricle has been recently highlighted. 119 Although less commonly present, similar features to those described for the left ventricle can be explored and described in the right ventricle (RVEF, aneurysms, thrombus, fibrosis, and inflammation patterns). 113,119 Advanced RV dysfunction is frequently present in ChHD once severe LV dysfunction has developed.…”

Section: Vc Rv Functionmentioning

confidence: 84%

Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC)

Acquatella

Asch

Barbosa

et al. 2018

Journal of the American Society of Echocardiography

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Section: Vc Rv Functionmentioning

confidence: 84%

Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC)

Acquatella

Asch

Barbosa

et al. 2018

Journal of the American Society of Echocardiography

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Background: Chagas disease is related to ischemic stroke (IS), although few epidemiological studies have evaluated the associated mortality and recurrence. Our objective is to determine factors associated with mortality and recurrence of IS in patients with IS and Chagas disease. Methods: We retrospectively studied data obtained from electronic medical records of patients admitted at SARAH Hospitals across Brazil between 2009 and 2013. Using Cox regression analysis for mortality and logistic regression for recurrence, we assessed primary population characteristics and statistical associations between risk factors and outcomes. Results: We analyzed 279 patients who were followed up until 2016. The mean age at stroke onset was 61 with a 10% frequency of death. Multivariate analysis assessing mortality demonstrated that the associated factors were age at stroke (hazard ratio [HR] 1.04), initial modified Rankin Scale (mRS; HR 20.91), bladder dysfunction (HR 2.51), diabetes mellitus (DM; HR 3.64), and alcoholism (HR 3.37). Multivariate analysis assessing recurrence demonstrated that the associated factors were age at ictus (OR 0.96), cognitive deficit (OR 0.44), initial mRS (OR 1.84), cardioembolic etiology (OR 2.47), and female sex (OR 2.73). Conclusions: Cardiac conditions did not correlate with mortality or recurrence. Age was a protective factor against recurrence, probably due to cumulative risk of IS over time, while initial mRS was associated with both outcomes. Treating diseases such as DM and bladder dysfunction, and early treatment to reduce the initial mRS could potentially prevent both outcomes; also, establishing a correct etiological diagnosis is important.

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“…Cardiac magnetic resonance methods have inherent advantages for the evaluation of RVEF, since volumes can be directly measured instead of being geometrically extrapolated [ 51 ]. Studying 158 subjects with CD using cardiac magnetic resonance, Moreira et al described reduced right ventricular ejection fraction in 37% of the patients studied [ 51 ]. Although usually associated with LV dysfunction, isolated early right ventricular dysfunction was also found in a small subset (4.4%) of patients [ 51 ].…”

Section: Evidence Of Right Ventricle Involvement In Chagas Diseasementioning

confidence: 99%

“…Studying 158 subjects with CD using cardiac magnetic resonance, Moreira et al described reduced right ventricular ejection fraction in 37% of the patients studied [ 51 ]. Although usually associated with LV dysfunction, isolated early right ventricular dysfunction was also found in a small subset (4.4%) of patients [ 51 ]. Furthermore, right ventricular dysfunction was independently associated with atrial fibrillation.…”

Section: Evidence Of Right Ventricle Involvement In Chagas Diseasementioning

confidence: 99%

Imaging Diagnosis of Right Ventricle Involvement in Chagas Cardiomyopathy

Romano

Moreira

Schmidt

et al. 2017

BioMed Research International

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Right ventricle (RV) is considered a neglected chamber in cardiology and knowledge about its role in cardiac function was mostly focused on ventricular interdependence. However, progress on the understanding of myocardium diseases primarily involving the RV led to a better comprehension of its role in health and disease. In Chagas disease (CD), there is direct evidence from both basic and clinical research of profound structural RV abnormalities. However, clinical detection of these abnormalities is hindered by technical limitations of imaging diagnostic tools. Echocardiography has been a widespread and low-cost option for the study of patients with CD but, when applied to the RV assessment, faces difficulties such as the absence of a geometrical shape to represent this cavity. More recently, the technique has evolved to a focused guided RV imaging and myocardial deformation analysis. Also, cardiac magnetic resonance (CMR) has been introduced as a gold standard method to evaluate RV cavity volumes. CMR advantages include precise quantitative analyses of both LV and RV volumes and its ability to perform myocardium tissue characterization to identify areas of scar and edema. Evolution of these cardiac diagnostic techniques opened a new path to explore the pathophysiology of RV dysfunction in CD.

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Evaluation of Right Ventricular Systolic Function in Chagas Disease Using Cardiac Magnetic Resonance Imaging

Abstract: In chronic Chagas disease, RV systolic dysfunction is more commonly associated with left ventricular systolic dysfunction, although isolated and early RV dysfunction can also be identified.

Cited by 22 publications

References 28 publications

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

Imaging Diagnosis of Right Ventricle Involvement in Chagas Cardiomyopathy

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