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. 2022 Dec;29(6):3166-3176.
doi: 10.1007/s12350-021-02869-3. Epub 2022 Jan 4.

Regional myocardial sympathetic denervation precedes the development of left ventricular systolic dysfunction in chronic Chagas' cardiomyopathy

Leonardo Pippa Gadioli  1 , Carlos Henrique Miranda  1 , José Antonio Marin-Neto  1 , Gustavo Jardim Volpe  1 , Antonio Carlos Leite Barros Filho  1 , Antonio Pazin Filho  1 , Antonio Osvaldo Pintya  1 , Alexandre Baldini de Figueiredo  1 , Marcus Vinicius Simões  2
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Regional myocardial sympathetic denervation precedes the development of left ventricular systolic dysfunction in chronic Chagas' cardiomyopathy

Leonardo Pippa Gadioli et al. J Nucl Cardiol. 2022 Dec.

Abstract

Background: Regional myocardial sympathetic denervation is a conspicuous and early disorder in patients with chronic Chagas' cardiomyopathy (CCC), potentially associated to the progression of myocardial dysfunction OBJECTIVE: To evaluate in a longitudinal study the association between the presence and the progression of regional myocardial sympathetic denervation with the deterioration of global and segmental left ventricular dysfunction in CCC.

Methods: 18 patients with CCC were submitted at initial evaluation and after 5.5 years to rest myocardial scintigraphy with 123Iodo-metaiodobenzylguanidine and 99mTc-sestamibi and to two-dimensional echocardiography to assess myocardial sympathetic denervation, extent of fibrosis, and the left ventricular ejection fraction (LVEF) and wall motion abnormalities.

Results: In the follow-up evaluation, compared to the initial one, we observed a significant decrease in LVEF (56 ± 11 to 49% ± 12; P = .01) and increased summed defects scores in the myocardial innervation scintigraphy (15 ± 10 to 20 ± 9; P < .01). The presence of regional myocardial sympathetic denervation in ventricular regions of viable non-fibrotic myocardium presented an odds ratio of 4.25 for the development of new wall motion abnormalities (P = .001).

Conclusion: Regional and global myocardial sympathetic denervation is a progressive derangement in CCC. In addition, the regional denervation is topographically associated with areas of future development of regional systolic dysfunction in patients with CCC.

Keywords: Chagas’ disease; Microvascular ischemia; Myocardial sympathetic denervation; Perfusion defect; Ventricular function.

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