Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy

Gustavo J. Volpe, Henrique T. Moreira, Henrique S. Trad, Katherine Chih-Ching Wu, Maria Fernanda Braggion-Santos, Marcel K. Santos, Benedito C. Maciel, Antonio Pazin-Filho, José Antonio Marin-Neto, Joao Lima, André Schmidt

Research output: Contribution to journalArticle

Abstract

Background: Patients with chronic Chagas cardiomyopathy (CCC) have pronounced myocardial fibrosis, which may predispose to sudden cardiac death, despite well-preserved global left ventricular (LV) systolic function. Cardiac magnetic resonance can assess myocardial fibrosis by late gadolinium enhancement (LGE) sequences. Objectives: This prospective study evaluated if the presence of scar by LGE predicted hard adverse outcomes in a cohort of patients with CCC. Methods: A prospective cohort of 140 patients with CCC (52.1% female; median age 57 years [interquartile range: 45 to 67 years]) were included. Cardiac magnetic resonance cine and LGE imaging were performed at enrollment with a 1.5-T scanner. The primary endpoint was the combination of cardiovascular death and sustained ventricular tachycardia. The secondary endpoint was the combination of cardiovascular death, sustained ventricular tachycardia, or cardiovascular hospitalization during follow-up. Results: After a median of 34 months (interquartile range: 24 to 49 months) of follow-up, 11 cardiovascular deaths, 3 episodes of sustained ventricular tachycardia, and 20 cardiovascular hospitalizations were recorded. LGE scar was present in 71.4% of the patients, with the lateral, inferolateral, and inferior walls most commonly affected. Patients with positive LGE had lower LV ejection fraction and higher LV end-diastolic volume and LV mass than patients without LGE. No difference in other cardiovascular risk factors was noted. Patients with scar had higher event rates compared with those without scar for the primary (p = 0.043) and the secondary (p = 0.016) endpoint. In multivariable analysis, age and LGE area were related to primary outcome; age and lower LV ejection fraction were related to the secondary outcome. The pattern of LGE myocardial fibrosis was transmural, focal, or diffuse scar in approximately one-third of patients with positive LGE, and no pattern was specifically related to outcomes. Conclusions: In patients with CCC, presence of scar by LGE is common and is strongly associated with major adverse outcomes.

Original languageEnglish (US)
Pages (from-to)2567-2576
Number of pages10
JournalJournal of the American College of Cardiology
Volume72
Issue number21
DOIs
StatePublished - Nov 27 2018

Fingerprint

Chagas Cardiomyopathy
Gadolinium
Cicatrix
Ventricular Tachycardia
Stroke Volume
Fibrosis
Hospitalization
Magnetic Resonance Spectroscopy
Sudden Cardiac Death
Left Ventricular Function

Keywords

  • Chagas
  • Chagas heart disease
  • clinical events
  • late gadolinium enhancement
  • MRI
  • scar

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Volpe, G. J., Moreira, H. T., Trad, H. S., Wu, K. C-C., Braggion-Santos, M. F., Santos, M. K., ... Schmidt, A. (2018). Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy. Journal of the American College of Cardiology, 72(21), 2567-2576. https://doi.org/10.1016/j.jacc.2018.09.035

Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy. / Volpe, Gustavo J.; Moreira, Henrique T.; Trad, Henrique S.; Wu, Katherine Chih-Ching; Braggion-Santos, Maria Fernanda; Santos, Marcel K.; Maciel, Benedito C.; Pazin-Filho, Antonio; Marin-Neto, José Antonio; Lima, Joao; Schmidt, André.

In: Journal of the American College of Cardiology, Vol. 72, No. 21, 27.11.2018, p. 2567-2576.

Research output: Contribution to journalArticle

Volpe, GJ, Moreira, HT, Trad, HS, Wu, KC-C, Braggion-Santos, MF, Santos, MK, Maciel, BC, Pazin-Filho, A, Marin-Neto, JA, Lima, J & Schmidt, A 2018, 'Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy', Journal of the American College of Cardiology, vol. 72, no. 21, pp. 2567-2576. https://doi.org/10.1016/j.jacc.2018.09.035
Volpe, Gustavo J. ; Moreira, Henrique T. ; Trad, Henrique S. ; Wu, Katherine Chih-Ching ; Braggion-Santos, Maria Fernanda ; Santos, Marcel K. ; Maciel, Benedito C. ; Pazin-Filho, Antonio ; Marin-Neto, José Antonio ; Lima, Joao ; Schmidt, André. / Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy. In: Journal of the American College of Cardiology. 2018 ; Vol. 72, No. 21. pp. 2567-2576.
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abstract = "Background: Patients with chronic Chagas cardiomyopathy (CCC) have pronounced myocardial fibrosis, which may predispose to sudden cardiac death, despite well-preserved global left ventricular (LV) systolic function. Cardiac magnetic resonance can assess myocardial fibrosis by late gadolinium enhancement (LGE) sequences. Objectives: This prospective study evaluated if the presence of scar by LGE predicted hard adverse outcomes in a cohort of patients with CCC. Methods: A prospective cohort of 140 patients with CCC (52.1{\%} female; median age 57 years [interquartile range: 45 to 67 years]) were included. Cardiac magnetic resonance cine and LGE imaging were performed at enrollment with a 1.5-T scanner. The primary endpoint was the combination of cardiovascular death and sustained ventricular tachycardia. The secondary endpoint was the combination of cardiovascular death, sustained ventricular tachycardia, or cardiovascular hospitalization during follow-up. Results: After a median of 34 months (interquartile range: 24 to 49 months) of follow-up, 11 cardiovascular deaths, 3 episodes of sustained ventricular tachycardia, and 20 cardiovascular hospitalizations were recorded. LGE scar was present in 71.4{\%} of the patients, with the lateral, inferolateral, and inferior walls most commonly affected. Patients with positive LGE had lower LV ejection fraction and higher LV end-diastolic volume and LV mass than patients without LGE. No difference in other cardiovascular risk factors was noted. Patients with scar had higher event rates compared with those without scar for the primary (p = 0.043) and the secondary (p = 0.016) endpoint. In multivariable analysis, age and LGE area were related to primary outcome; age and lower LV ejection fraction were related to the secondary outcome. The pattern of LGE myocardial fibrosis was transmural, focal, or diffuse scar in approximately one-third of patients with positive LGE, and no pattern was specifically related to outcomes. Conclusions: In patients with CCC, presence of scar by LGE is common and is strongly associated with major adverse outcomes.",
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AU - Moreira, Henrique T.

AU - Trad, Henrique S.

AU - Wu, Katherine Chih-Ching

AU - Braggion-Santos, Maria Fernanda

AU - Santos, Marcel K.

AU - Maciel, Benedito C.

AU - Pazin-Filho, Antonio

AU - Marin-Neto, José Antonio

AU - Lima, Joao

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N2 - Background: Patients with chronic Chagas cardiomyopathy (CCC) have pronounced myocardial fibrosis, which may predispose to sudden cardiac death, despite well-preserved global left ventricular (LV) systolic function. Cardiac magnetic resonance can assess myocardial fibrosis by late gadolinium enhancement (LGE) sequences. Objectives: This prospective study evaluated if the presence of scar by LGE predicted hard adverse outcomes in a cohort of patients with CCC. Methods: A prospective cohort of 140 patients with CCC (52.1% female; median age 57 years [interquartile range: 45 to 67 years]) were included. Cardiac magnetic resonance cine and LGE imaging were performed at enrollment with a 1.5-T scanner. The primary endpoint was the combination of cardiovascular death and sustained ventricular tachycardia. The secondary endpoint was the combination of cardiovascular death, sustained ventricular tachycardia, or cardiovascular hospitalization during follow-up. Results: After a median of 34 months (interquartile range: 24 to 49 months) of follow-up, 11 cardiovascular deaths, 3 episodes of sustained ventricular tachycardia, and 20 cardiovascular hospitalizations were recorded. LGE scar was present in 71.4% of the patients, with the lateral, inferolateral, and inferior walls most commonly affected. Patients with positive LGE had lower LV ejection fraction and higher LV end-diastolic volume and LV mass than patients without LGE. No difference in other cardiovascular risk factors was noted. Patients with scar had higher event rates compared with those without scar for the primary (p = 0.043) and the secondary (p = 0.016) endpoint. In multivariable analysis, age and LGE area were related to primary outcome; age and lower LV ejection fraction were related to the secondary outcome. The pattern of LGE myocardial fibrosis was transmural, focal, or diffuse scar in approximately one-third of patients with positive LGE, and no pattern was specifically related to outcomes. Conclusions: In patients with CCC, presence of scar by LGE is common and is strongly associated with major adverse outcomes.

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