Value of cardiac MRI for evaluation of chronic Chagas disease cardiomyopathy

Lee‐Felker, Stephanie; Thomas, Mariam; Felker, Ely; Traina, Mahmoud; Salih, Mohsin; Hernández, Salvador; Bradfield, Jason S.; Lee, M.; Meymandi, Sheba

doi:10.1016/j.crad.2016.02.015

Cited by 36 publications

(23 citation statements)

References 23 publications

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“…Myocardial fibrosis can be found in up to 8% of patients with positive serology for ChD despite normal ECG and echocardiographic findings. 70 Importantly, the presence and extent of myocardial fibrosis correlate well with the New York Heart Association functional class and likelihood of ventricular arrhythmias, particularly when a transmural pattern is found extending beyond two or more contiguous segments. 71,72 In addition, myocardial fibrosis inversely correlates with LV systolic function.…”

Section: Ivc Cardiac Magnetic Resonance and Computed Tomographymentioning

confidence: 96%

“…35,129 This rate of conversion may be higher if cardiac examination is performed with more sensitive imaging techniques for detection of early myocardial damage, such as advanced echocardiography (strain) or CMR (for fibrosis and inflammation). 4,61,70 Indeed, anatomopathologic studies with endomyocardial biopsy have demonstrated fibrosis or inflammatory cardiac damage in patients with ChD with no otherwise apparent cardiomyopathy. 130 Electrocardiography has been the traditional modality of choice for ChD, both because of the specificity of its findings in endemic areas and because of the excellent prognosis associated with normal ECG findings.…”

Section: Vibi Silent or Asymptomatic Chd (Stages A B1 And B2)mentioning

confidence: 99%

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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: Ivc Cardiac Magnetic Resonance and Computed Tomographymentioning

confidence: 96%

Section: Vibi Silent or Asymptomatic Chd (Stages A B1 And B2)mentioning

confidence: 99%

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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“…Cardiac magnetic resonance imaging enables better assessment of cardiac anatomy and biventricular function than ECHO, thus making this a very specific technique for appropriately characterizing CCM. 4,[19][20][21][22] The cardiac abnormalities we detected in 50% of the CMR studies included late myocardial enhancement (suspected of being related to malignant arrhythmias and sudden cardiac death), right ventricular dysfunction, and myocardial edema (suggestive of the persistence of inflammatory processes in the myocardium as described in previous studies). 23 The addition of conventional echocardiogram to ECG, as in our cohort, significantly increases the number of patients with cardiac abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Noninvasive Cardiac Test Strategies for Newly Diagnosed Chagas Disease in a Non-Endemic Zone

Refoyo

Troya

Trigo

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Chagas disease is an emerging infectious disease in Europe and other non-endemic areas, mainly owing to migration from endemic areas. We aimed at investigating the value of advanced echocardiography (ECHO) and cardiac magnetic resonance (CMR) in patients newly diagnosed with Chagas disease to compare findings with those of electrocardiogram (ECG) and conventional ECHO and thus detecting cardiac abnormalities. We included consecutive patients with newly diagnosed Chagas disease and registered cardiac test results (ECG, ECHO, and CMR). We divided ECHO parameters into three tiers: 1) left ventricular ejection fraction, regional wall motion abnormality, and left ventricular diastolic dimension (ECHO-1); 2) other common ECHO parameters (ECHO-2); and 3) global longitudinal strain (GLS) (ECHO-3). Cardiac magnetic resonance included global and segmental biventricular function, the presence of myocardial fibrosis, and edema. The study comprised 100 patients from South America. The mean age was 43.9 ± 0.9 years, and 66% were women. Mean time living in Spain was 9.7 ± 0.5 years. The ECG revealed ³ 2 abnormal findings in 47% of patients. ECHO-1 was abnormal in 22% of patients, ECHO-2 in 52%, and GLS in 16%. Cardiac magnetic resonance was abnormal in 50% of cases, and in 3% of these, ECHO was normal. When ECG and conventional ECHO were taken together, abnormalities were detected in 83% of patients. This value increased to 86% and 92% for GLS and CMR, respectively. These findings suggest that ECG and conventional ECHO should be used routinely as standard cardiac tests for newly diagnosed cases of Chagas disease. The value of advanced ECHO techniques and CMR is low.

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“…Echocardiography is a widely available imaging option that may help establish baseline characteristics regarding all cardiac chambers and LV systolic and diastolic function size. Another high-yield assessment tool is cardiac magnetic resonance (CMR), which has proven to be excellent at imaging cardiac anatomy and function with remarkable ability to determine ventricular size and function and characterize cardiac tissue to identify myocardial fibrosis (MF) [ 81 ]. Late gadolinium enhancement (LGE) and T1 sequences provide an excellent depiction of scars, edema, and MF in Ch-CMP [ 82 , 83 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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

et al. 2021

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Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community’s apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host–parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease’s clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy’s (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.

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Value of cardiac MRI for evaluation of chronic Chagas disease cardiomyopathy

Cited by 36 publications

References 23 publications

Comparison of Noninvasive Cardiac Test Strategies for Newly Diagnosed Chagas Disease in a Non-Endemic Zone

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

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