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CLINICAL RESEARCH: HYPERTROPHIC CARDIOMYOPATHY

Myocardial Delayed Enhancement by Magnetic Resonance Imaging in Patients With Chagas’ Disease

A Marker of Disease Severity

Carlos E. Rochitte, MD^_*,_*, Paulo F. Oliveira, MD^_*, Joalbo M. Andrade, MD^_*, Bárbara M. Ianni, MD^_*, José R. Parga, MD^_*, Luiz F. Ávila, MD^_*, Roberto Kalil-Filho, MD, FACC^_*, Charles Mady, MD^_*, José C. Meneghetti, MD^_*, João A.C. Lima, MD, FACC and José A.F. Ramires, MD, FACC^_*

^_* Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
Cardiolgy Division, Department of Medicine, Johns Hopkins University, Baltimore, Maryland

Manuscript received January 5, 2005; revised manuscript received May 23, 2005, accepted June 20, 2005.

^_* Reprint requests and correspondence: Dr. Carlos E. Rochitte, Director of Cardiovascular MRI and CT, Instituto do Coração (InCor), Setor de Ressonância Magnética Cardiovascular, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, Brazil, 05403–000 (Email: rochitte{at}incor.usp.br).

OBJECTIVES: We sought to investigate whether myocardial delayed enhancement (MDE) by magnetic resonance imaging (MRI) could quantify myocardial fibrosis (MF) in patients with Chagas’ heart disease (CHD), thus defining the severity of the disease.

BACKGROUND: Myocardial fibrosis secondary to ischemic disease can be imaged using MDE. Advanced CHD is characterized by progressive MF.

METHODS: Fifty-one patients with CHD were enrolled: 15 seropositive asymptomatic participants in the indeterminate phase (IND); 26 patients with known clinical CHD; and 10 patients with known CHD and ventricular tachycardia (VT). Using a 1.5-T MRI system, we acquired left ventricular (LV) short-axis slices using cine-MRI (LV function) and inversion-recovery gradient-echo (MDE).

RESULTS: Myocardial fibrosis by MRI was present in 68.6% of all patients, in 20% of IND, 84.6% of CHD, and 100% of VT (p < 0.001). Quantified MF increased progressively across disease severity subgroups (0.9 ± 2.3% in IND; 16.0 ± 12.3% in CHD; and 25.4 ± 9.8% in VT, p < 0.001) and New York Heart Association functional classes (I: 7.5 ± 9.5%; II: 21.9 ± 13.8%; and III: 25.3 ± 9.9% of LV mass, p < 0.001). Left ventricular ejection fraction and MF had significant negative correlation (r = –0.78, p < 0.001), similar to the segmental MF and function: 4.9 ± 15.1% of MF in normal function, 32.5 ± 32.5% in mildly hypokinetic, 57.8 ± 31.4% in severely hypokinetic, and 72.3 ± 36.2% in akinetic and dyskinetic segments, respectively (p < 0.001).

CONCLUSIONS: In CHD, MDE by MRI quantifies MF that not only can be detected in the early asymptomatic stages but parallels well-established prognostic factors and provides unique information for clinical disease staging.

Abbreviations and Acronyms   CAD = coronary artery disease   CHD = Chagas’ heart disease   IND = indeterminate phase group   LV = left ventricular   LVEF = left ventricular ejection fraction   MDE = myocardial delayed enhancement   MF = myocardial fibrosis   MRI = magnetic resonance imaging   NYHA = New York Heart Association   VT = ventricular tachycardia

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