Associations between Cardiac Magnetic Resonance T1 Mapping Parameters and Ventricular Arrhythmia in Patients with Chagas Disease

• DOI: 10.4269/ajtmh.20-0122
• Publication Date: 2020-05-19T07:01:46Z
• Authors: Martha Valéria Ta...; Renata Junqueira ...; Gabriel Cordeiro ...; Fabio Paiva Siqueira; Clerio Francisco ...; Marcelo Teixeira ...; Fernanda de Souza...; Luiz Henrique Con...; Mauro Felippe Fel...; Andréa Silvestre ...
• Keywords: Chagas Cardiomyopathy; Male; Myocardium; Magnetic Resonance Imaging, Cine; Heart; Organ Size; Middle Aged; Fibrosis; Magnetic Resonance Imaging; 3. Good health; 03 medical and health sciences; Cross-Sectional Studies; Logistic Models; 0302 clinical medicine; Echocardiography; Area Under Curve; Case-Control Studies; Electrocardiography, Ambulatory; Humans; Chagas Disease; Female; Extracellular Space; Aged

Chronic Chagas disease can progress to myocardial involvement with intense fibrosis, which may predispose patients to sudden cardiac death through ventricular arrhythmia. The associations of myocardial fibrosis detected by cardiac magnetic resonance (CMR) parameters with non-sustained ventricular tachycardia (NSVT) were evaluated. This cross-sectional study included patients in early stages of Chagas disease (n = 47) and a control group (n = 15). Patients underwent cardiac evaluation, including CMR examination. Myocardial fibrosis assessment by CMR with measurement of late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) was performed. There was an increase in myocardial fibrosis CMR parameters and ventricular arrhythmias among different stages of Chagas disease, combined with a decrease in the left ventricular ejection fraction (LVEF) by CMR and also in the right ventricular systolic function by S' wave on tissue Doppler. Fibrosis mass and ECV were associated with the Rassi score, ventricular extrasystole, and E/e' ratio in a logistic regression model adjusted for age and gender. The ECV maintained an association with the presence of NSVT, even after adjustments for fibrosis mass and LVEF assessed by CMR. The receiver-operating characteristic area under the curve for global ECV (0.85; 95% CI: 0.71-0.99) and NSVT was greater than that for fibrosis mass (0.75; 95% CI: 0.54-0.96), although this difference was not statistically significant. Extracellular volume could be an early marker of increased risk of ventricular arrhythmia in Chagas disease, presenting an independent association with NSVT in the initial stages of chronic Chagas cardiomyopathy, even after adjustment for fibrosis mass and LVEF.