Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chagas' cardiomyopathy

Ronaldo Peixoto de Mello, Gilberto Szarf, Paulo Roberto Schvartzman, Edson Minoru Nakano, Mariano Martinez Espinosa, Denis Szejnfeld, Verônica Fernandes, Joao Lima, Claudio Cirenza, Angelo A V De Paola

Research output: Contribution to journalArticle

Abstract

Background: Invasive and non-invasive tests have been used to identify the risk of ventricular tachycardia (VT) in patients with chagas' cardiomyopathy (CCM). Cardiac magnetic resonance imaging (CMRI) using the delayed enhancement (DE) technique can be useful to select patients with global or segmentary ventricular dysfunction, with high degree of fibrosis and at higher risk for clinical VT. Objective: To improve the identification of predictors of VT in patients with CCM. Methods: This study assessed 41 patients with CCM [30 (72%) males; mean age, 55.1 ± 11.9 years]. Twenty-six patients had history of VT (VT group), and 15 had no VT (NVT group). All patients enrolled had DE and segmentary ventricular dysfunction. In each case, the following variables were determined: left ventricular volume; percentage of ventricular wall thickness impairment in each segment; and DE distribution. Results: No statistical difference regarding the DE volume between both groups was observed: VT group = 30.0 ± 16.2%; NVT group = 21.7 ± 15.7%; p = 0.118. The probability of VT was greater in the presence of two or more contiguous transmural fibrosis areas, and that was a predictive factor of clinical VT (RR 4.1; p = 0,04). Agreement between observers was 100% regarding that criterion (p <0.001). Conclusion: The identification of two or more segments of transmural DE by use of CMRI is associated with the occurrence of clinical VT in patients with CCM. Thus, CMRI improved risk stratification in the population studied.

Original languageEnglish (US)
Pages (from-to)421-430
Number of pages10
JournalArquivos Brasileiros de Cardiologia
Volume98
Issue number5
DOIs
StatePublished - May 2012

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Chagas Cardiomyopathy
Ventricular Tachycardia
Magnetic Resonance Imaging
Ventricular Dysfunction
Fibrosis

Keywords

  • Cardiac magnetic resonance imaging
  • Chagas' cardiomyopathy
  • Tachycardia ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

de Mello, R. P., Szarf, G., Schvartzman, P. R., Nakano, E. M., Espinosa, M. M., Szejnfeld, D., ... De Paola, A. A. V. (2012). Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chagas' cardiomyopathy. Arquivos Brasileiros de Cardiologia, 98(5), 421-430. https://doi.org/10.1590/S0066-782X2012005000031

Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chagas' cardiomyopathy. / de Mello, Ronaldo Peixoto; Szarf, Gilberto; Schvartzman, Paulo Roberto; Nakano, Edson Minoru; Espinosa, Mariano Martinez; Szejnfeld, Denis; Fernandes, Verônica; Lima, Joao; Cirenza, Claudio; De Paola, Angelo A V.

In: Arquivos Brasileiros de Cardiologia, Vol. 98, No. 5, 05.2012, p. 421-430.

Research output: Contribution to journalArticle

de Mello, RP, Szarf, G, Schvartzman, PR, Nakano, EM, Espinosa, MM, Szejnfeld, D, Fernandes, V, Lima, J, Cirenza, C & De Paola, AAV 2012, 'Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chagas' cardiomyopathy', Arquivos Brasileiros de Cardiologia, vol. 98, no. 5, pp. 421-430. https://doi.org/10.1590/S0066-782X2012005000031
de Mello, Ronaldo Peixoto ; Szarf, Gilberto ; Schvartzman, Paulo Roberto ; Nakano, Edson Minoru ; Espinosa, Mariano Martinez ; Szejnfeld, Denis ; Fernandes, Verônica ; Lima, Joao ; Cirenza, Claudio ; De Paola, Angelo A V. / Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chagas' cardiomyopathy. In: Arquivos Brasileiros de Cardiologia. 2012 ; Vol. 98, No. 5. pp. 421-430.
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abstract = "Background: Invasive and non-invasive tests have been used to identify the risk of ventricular tachycardia (VT) in patients with chagas' cardiomyopathy (CCM). Cardiac magnetic resonance imaging (CMRI) using the delayed enhancement (DE) technique can be useful to select patients with global or segmentary ventricular dysfunction, with high degree of fibrosis and at higher risk for clinical VT. Objective: To improve the identification of predictors of VT in patients with CCM. Methods: This study assessed 41 patients with CCM [30 (72{\%}) males; mean age, 55.1 ± 11.9 years]. Twenty-six patients had history of VT (VT group), and 15 had no VT (NVT group). All patients enrolled had DE and segmentary ventricular dysfunction. In each case, the following variables were determined: left ventricular volume; percentage of ventricular wall thickness impairment in each segment; and DE distribution. Results: No statistical difference regarding the DE volume between both groups was observed: VT group = 30.0 ± 16.2{\%}; NVT group = 21.7 ± 15.7{\%}; p = 0.118. The probability of VT was greater in the presence of two or more contiguous transmural fibrosis areas, and that was a predictive factor of clinical VT (RR 4.1; p = 0,04). Agreement between observers was 100{\%} regarding that criterion (p <0.001). Conclusion: The identification of two or more segments of transmural DE by use of CMRI is associated with the occurrence of clinical VT in patients with CCM. Thus, CMRI improved risk stratification in the population studied.",
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AU - de Mello, Ronaldo Peixoto

AU - Szarf, Gilberto

AU - Schvartzman, Paulo Roberto

AU - Nakano, Edson Minoru

AU - Espinosa, Mariano Martinez

AU - Szejnfeld, Denis

AU - Fernandes, Verônica

AU - Lima, Joao

AU - Cirenza, Claudio

AU - De Paola, Angelo A V

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N2 - Background: Invasive and non-invasive tests have been used to identify the risk of ventricular tachycardia (VT) in patients with chagas' cardiomyopathy (CCM). Cardiac magnetic resonance imaging (CMRI) using the delayed enhancement (DE) technique can be useful to select patients with global or segmentary ventricular dysfunction, with high degree of fibrosis and at higher risk for clinical VT. Objective: To improve the identification of predictors of VT in patients with CCM. Methods: This study assessed 41 patients with CCM [30 (72%) males; mean age, 55.1 ± 11.9 years]. Twenty-six patients had history of VT (VT group), and 15 had no VT (NVT group). All patients enrolled had DE and segmentary ventricular dysfunction. In each case, the following variables were determined: left ventricular volume; percentage of ventricular wall thickness impairment in each segment; and DE distribution. Results: No statistical difference regarding the DE volume between both groups was observed: VT group = 30.0 ± 16.2%; NVT group = 21.7 ± 15.7%; p = 0.118. The probability of VT was greater in the presence of two or more contiguous transmural fibrosis areas, and that was a predictive factor of clinical VT (RR 4.1; p = 0,04). Agreement between observers was 100% regarding that criterion (p <0.001). Conclusion: The identification of two or more segments of transmural DE by use of CMRI is associated with the occurrence of clinical VT in patients with CCM. Thus, CMRI improved risk stratification in the population studied.

AB - Background: Invasive and non-invasive tests have been used to identify the risk of ventricular tachycardia (VT) in patients with chagas' cardiomyopathy (CCM). Cardiac magnetic resonance imaging (CMRI) using the delayed enhancement (DE) technique can be useful to select patients with global or segmentary ventricular dysfunction, with high degree of fibrosis and at higher risk for clinical VT. Objective: To improve the identification of predictors of VT in patients with CCM. Methods: This study assessed 41 patients with CCM [30 (72%) males; mean age, 55.1 ± 11.9 years]. Twenty-six patients had history of VT (VT group), and 15 had no VT (NVT group). All patients enrolled had DE and segmentary ventricular dysfunction. In each case, the following variables were determined: left ventricular volume; percentage of ventricular wall thickness impairment in each segment; and DE distribution. Results: No statistical difference regarding the DE volume between both groups was observed: VT group = 30.0 ± 16.2%; NVT group = 21.7 ± 15.7%; p = 0.118. The probability of VT was greater in the presence of two or more contiguous transmural fibrosis areas, and that was a predictive factor of clinical VT (RR 4.1; p = 0,04). Agreement between observers was 100% regarding that criterion (p <0.001). Conclusion: The identification of two or more segments of transmural DE by use of CMRI is associated with the occurrence of clinical VT in patients with CCM. Thus, CMRI improved risk stratification in the population studied.

KW - Cardiac magnetic resonance imaging

KW - Chagas' cardiomyopathy

KW - Tachycardia ventricular

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