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Review
. 2020 May 8;5(2):74.
doi: 10.3390/tropicalmed5020074.

New Imaging Parameters to Predict Sudden Cardiac Death in Chagas Disease

Renata J Moll-Bernardes  1 , Paulo Henrique Rosado-de-Castro  1   2 , Gabriel Cordeiro Camargo  1 , Fernanda Souza Nogueira Sardinha Mendes  3 , Adriana S X Brito  1 , Andréa Silvestre Sousa  1   2   3
Affiliations
Review

New Imaging Parameters to Predict Sudden Cardiac Death in Chagas Disease

Renata J Moll-Bernardes et al. Trop Med Infect Dis. .

Abstract

Chronic Chagas' cardiomyopathy is the most severe and frequent manifestation of Chagas disease, and has a high social and economic burden. New imaging modalities, such as strain echocardiography, nuclear medicine, computed tomography and cardiac magnetic resonance imaging, may detect the presence of myocardial fibrosis, inflammation or sympathetic denervation, three conditions associated with risk of sudden death, providing additional diagnostic and/or prognostic information. Unfortunately, despite its high mortality, there is no clear recommendation for early cardioverter-defibrillator implantation in patients with Chagas heart disease in the current guidelines. Ideally, the risk of sudden cardiac death may be evaluated in earlier stages of the disease using new image methods to allow the implementation of primary preventive strategies.

Keywords: Chagas disease; PET-CT; SPECT-CT; cardiac magnetic resonance; cardiomyopathy; inflammation; myocardial fibrosis; myocardial sympathetic denervation; radionuclide imaging; sudden death.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Global longitudinal strain of the left ventricle and strain curves depicting increased mechanical dispersion. Abnormal findings of left ventricular (LV) longitudinal strain in apical three-chamber view (top left); apical two-chamber view (bottom left); apical four-chamber view (bottom right); “Bull’s-eye” plot of strain values for each myocardial segment evidences anteroseptal and inferolateral akinesia represented by blue areas in the polar map (top right).
Figure 2
Figure 2
Cardiac magnetic resonance (CMR) four chamber image showing a typical left ventricular mamillar apical aneurysm (arrow). CMR: cardiac magnetic resonance.
Figure 3
Figure 3
CMR images in four chamber (A) and three chamber (B) views showing meso-epicardial (arrows) and apical transmural (arrowheads) late gadolinium enhancement (LGE). CMR: cardiac magnetic resonance; LGE: late gadolinium enhancement.
Figure 4
Figure 4
Four chamber image with color-coded native (non-contrast) T1 map, indicating the presence of mesocardial septal fibrosis (arrow) and apical transmural fibrosis (arrowheads). Increased native T1 is represented by yellow areas within the myocardium.
Figure 5
Figure 5
Automatic quantification (polar map) from rest 99m-Technetium sestamibi scintigraphy demonstrating reduced myocardial perfusion in apical region in a patient with a small aneurism of the left ventricular apex.
Figure 6
Figure 6
Multigated acquisition (MUGA) scan demonstrating reduced ejection fraction (EF = 21%) in a patient with Chagasic cardiomyopathy. This radionuclide ventriculography technique is a highly accurate test, used to determine the heart’s pumping function, and it shows substantial reproducibility and low intraobserver and interobserver variability.
Figure 7
Figure 7
A 123I-MIBG scintigraphy planar scintigraphy in anterior view at 3 h (A) to evaluate the sympathetic innervation a patient with Chagasic cardiomyopathy and ventricular arrhythmia. Heart to mediastinum ratio at 3 h was reduced and radiotracer washout was increased. Single photon emission computed tomography (SPECT)-computed tomography (CT) images in coronal (B), sagittal (C) and transversal (D) planes demonstrated reduced cardiac uptake of 123I-MIBG in apical, inferior and lateral regions indicating sympathetic denervation in these areas and a worse prognosis.
Figure 8
Figure 8
Increased cardiac volume in a patient with Chagasic cardiomyopathy. Mild increase in uptake of 18F-FDG (A,B) and of 68Ga-DOTATOC (C,D) in positron emission tomography (PET)-CT images was restricted to the basal anterolateral segment, indicating the presence of inflammation in this segment.
Figure 9
Figure 9
New imaging modalities can detect abnormalities involved in the genesis of ventricular arrythmia. SCD: Sudden cardiac death.
See this image and copyright information in PMC

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