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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

View larger version (69K): [in a new window]   Figure 1 Myocardial delayed enhancement (arrowheads) on left ventricular short-axis slices in different stages of Chagas' disease. CHD = Chagas' heart disease group; IND = indeterminate phase group; VT = Chagas' heart disease with ventricular tachycardia group.

View larger version (15K): [in a new window]   Figure 2 Increase in myocardial fibrosis (MF) over New York Heart Association functional classes (p < 0.001 by analysis of variance). Class I had less MF than classes II and III (multiple [3] comparisons by Bonferroni test, with adjusted p value for significance p < 0.016: I vs. II p < 0.001; II vs. III p = 1.0; I vs. III p = 0.012). LV = left ventricular.

View larger version (128K): [in a new window]   Figure 3 Extent of myocardial fibrosis (MF) (arrows) and left ventricular function. (A) Patient with small area of MF (8.2%) and normal left ventricular ejection fraction (65.5%). (B) Patient with large area of MF (23.8%) and severe left ventricular dysfunction (left ventricular ejection fraction 19.2%). MDE = myocardial delayed enhancement; MRI = magnetic resonance imaging.

View larger version (22K): [in a new window]   Figure 4 Good correlation between left ventricular ejection fraction (LVEF) and myocardial fibrosis (MF). Patients with LVEF >40% had less quantified MF than those with LVEF 40% (Student t test).

View larger version (56K): [in a new window]   Figure 5 Left ventricular 17-segment model showing concentration on apex, inferolateral, and inferior segments (shaded area) of regional myocardial delayed enhancement (MDE) (A) (51.3%, p < 0.001 by the Fisher exact test and p = 0.002 by logistic regression) and wall motion abnormality (B) (51.7%, p < 0.001 by the Fisher exact test and by logistic regression). Absolute number of segments and (percent values) are shown.

View larger version (14K): [in a new window]   Figure 6 Segmental left ventricular function and extent of myocardial fibrosis (MF). A progressive and significant increase of MF along with the loss of segmental contractile activity can be observed.

View larger version (120K): [in a new window]   Figure 7 A ventricular tachycardia group patient with typical apical and inferolateral myocardial fibrosis by magnetic resonance imaging (arrows in bottom, middle, and left columns) and normal coronary arteries by angiography (top, middle, and left columns). The left ventricular (LV) apical aneurysm (vorticilar) observed on the ventriculogram (arrow, top right column) and cine-magnetic resonance imaging (arrow, bottom right column) is a classical finding of Chagas' heart disease. MDE = myocardial delayed enhancement; RCA = right coronary artery/