TY - JOUR
T1 - Myocardial delayed enhancement by magnetic resonance imaging in patients with Chagas' disease
T2 - A marker of disease severity
AU - Rochitte, Carlos E.
AU - Oliveira, Paulo F.
AU - Andrade, Joalbo M.
AU - Ianni, Bárbara M.
AU - Parga, José R.
AU - Ávila, Luiz F.
AU - Kalil-Filho, Roberto
AU - Mady, Charles
AU - Meneghetti, José C.
AU - Lima, João A.C.
AU - Ramires, José A.F.
N1 - Funding Information:
Supported by FAPESP (Fundação de Amparo ã Pesquisa do Estado de São Paulo) Grant 01/04358–0 and the Zerbini Foundation.
PY - 2005/10/18
Y1 - 2005/10/18
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jacc.2005.06.067
DO - 10.1016/j.jacc.2005.06.067
M3 - Article
C2 - 16226184
AN - SCOPUS:26844500366
SN - 0735-1097
VL - 46
SP - 1553
EP - 1558
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -