CLINICAL RESEARCH
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 |
|
This article has been cited by other articles:
|
|
|
|
 
M. R. Patel, P. J. Cawley, J. F. Heitner, I. Klem, M. A. Parker, W. A. Jaroudi, T. J. Meine, J. B. White, M. D. Elliott, H. W. Kim, et al.
Detection of Myocardial Damage in Patients With Sarcoidosis
Circulation,
November 17, 2009;
120(20):
1969 - 1977.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer
The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure
J. Am. Coll. Cardiol.,
October 6, 2009;
54(15):
1407 - 1424.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. J. Sparrow, N. Merchant, Y. L. Provost, D. J. Doyle, E. T. Nguyen, and N. S. Paul
CT and MR Imaging Findings in Patients with Acquired Heart Disease at Risk for Sudden Cardiac Death1
RadioGraphics,
May 1, 2009;
29(3):
805 - 823.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Alpendurada, J Wong, and D J Pennell
Practical applications of cardiovascular magnetic resonance
Heart Asia,
March 31, 2009;
2009(3):
16 - 22.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Nazarian, D. A. Bluemke, and H. R. Halperin
Applications of Cardiac Magnetic Resonance in Electrophysiology
Circ Arrhythm Electrophysiol,
February 1, 2009;
2(1):
63 - 71.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. C. Hiss, T. F. Lascala, B. C. Maciel, J. A. Marin-Neto, and M. V. Simoes
Changes in myocardial perfusion correlate with deterioration of left ventricular systolic function in chronic Chagas' cardiomyopathy.
J. Am. Coll. Cardiol. Img.,
February 1, 2009;
2(2):
164 - 172.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Schwartz and O. Wexler
Early identification and monitoring progression of Chagas' cardiomyopathy with SPECT myocardial perfusion imaging.
J. Am. Coll. Cardiol. Img.,
February 1, 2009;
2(2):
173 - 175.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W P Bandettini and A E Arai
Advances in clinical applications of cardiovascular magnetic resonance imaging
Heart,
November 1, 2008;
94(11):
1485 - 1495.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Germans and A. C van Rossum
The use of cardiac magnetic resonance imaging to determine the aetiology of left ventricular disease and cardiomyopathy
Heart,
April 1, 2008;
94(4):
510 - 518.
[Full Text]
[PDF]
|
|
|
|
|
|
|
U Sechtem, H Mahrholdt, and H Vogelsberg
Cardiac magnetic resonance in myocardial disease
Heart,
December 1, 2007;
93(12):
1520 - 1527.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. R. S. Fernandes, K. C. Wu, B. D. Rosen, A. Schmidt, A. C. Lardo, N. Osman, H. R. Halperin, G. Tomaselli, R. Berger, D. A. Bluemke, et al.
Enhanced Infarct Border Zone Function and Altered Mechanical Activation Predict Inducibility of Monomorphic Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy
Radiology,
December 1, 2007;
245(3):
712 - 719.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. C. Silva, Z. M. A. Meira, J. Gurgel Giannetti, M. M. da Silva, A. F. Oliveira Campos, M. de Melo Barbosa, G. M. S. Filho, R. de Aguiar Ferreira, M. Zatz, and C. E. Rochitte
Myocardial Delayed Enhancement by Magnetic Resonance Imaging in Patients With Muscular Dystrophy
J. Am. Coll. Cardiol.,
May 8, 2007;
49(18):
1874 - 1879.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Acquatella
Echocardiography in Chagas Heart Disease
Circulation,
March 6, 2007;
115(9):
1124 - 1131.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Mahrholdt, A. Wagner, C. C. Deluigi, E. Kispert, S. Hager, G. Meinhardt, H. Vogelsberg, P. Fritz, J. Dippon, C. -T. Bock, et al.
Presentation, Patterns of Myocardial Damage, and Clinical Course of Viral Myocarditis
Circulation,
October 10, 2006;
114(15):
1581 - 1590.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
