Myocardial involvement in Chagas disease: Insights from cardiac magnetic resonance
Section snippets
Background
Chagas' disease represents a major cause of morbidity and mortality in Latin America [1] and an emerging health problem in countries where the disease is not endemic as a result of growing population's movements [2], [3], [4]. Chronic Chagas' cardiomyopathy (CCC) is the most serious and frequent manifestation of Chagas' disease and the main cause of mortality among these patients [5] and is associated to a poorer survival compared with other forms of cardiomyopathies [6]. Currently, the
Study population
Consecutive Chagas' disease patients evaluated at our Institution who underwent CMR from July 2007 to March 2010 were included. All patients received T. cruzi serological tests. Diagnosis of Chagas' disease was established on microbiologic confirmation by any combinations of at least two positive commercial serological tests using different antigens [14]: ELISA using T. cruzi lysate (Ortho-Clinical Diagnostics ®, Johnson & Johnson), ELISA with recombinant antigens (BioELISA Chagas®, Biokit) and
Patient characteristics
A total of 67 consecutive patients were included, 27 patients in Group 1, 19 patients in Group 2 and 21 patients in Group 3. All patients were originally from Latin America, the highest proportion was from Bolivia (N = 57, 85.1%) and the remaining subjects were from Brazil (N = 2, 3.0%), Venezuela (N = 1, 1.5%), Colombia (N = 2, 3.0%), Paraguay (N = 2, 3.0%) and Ecuador (N = 1, 1.5%). All of them were residents in Spain at the time of inclusion in the study. Patient characteristics are shown in Table 1.
Discussion
The aim of our study was to characterize the CMR pattern in a wide spectrum of Chagas' disease patients living in non-endemic areas. The most significant findings are the following: first, DE indicating myocardial scar or fibrosis was present in an important percentage of patients (more than 50% of patients with echocardiographic abnormalities) and was associated with other markers of LV involvement; second, DE was predominantly found in the apex and infero-lateral wall of the LV and had a very
Funding
This work was partially supported by a grant from the Fondo de Investigaciones Sanitarias (FIS), Instituto de Salud Carlos III, Madrid, Spain [PI 070773] and from Department d'Universitats, Recerca y Societat de la Informació de la Generalitat de Catalunya, Spain [2009SGR385].
Acknowledgements
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
References (36)
- et al.
Chagas disease in Spain, the United States and other non-endemic countries
Acta Trop
(2010) Clinical and epidemiological aspects of Chagas disease
Lancet Infect Dis
(2001)Predicting heart failure and mortality in chronic Chagas' heart disease, a novel disorder in Spain
Rev Esp Cardiol
(2008)- et al.
Rationale and design of a randomized placebo-controlled trial assessing the effects of etiologic treatment in Chagas' cardiomyopathy: the BENznidazole evaluation for interrupting trypanosomiasis (BENEFIT)
Am Heart J
(2008) - et al.
ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
J Am Coll Cardiol
(2010) - et al.
Myocardial delayed enhancement by magnetic resonance imaging in patients with Chagas' disease: a marker of disease severity
J Am Coll Cardiol
(2005) The pattern of myocardial fibrosis in chronic Chagas' heart disease
Int J Cardiol
(1991)- et al.
Trypanosoma cruzi reinfections in mice determine the severity of cardiac damage
Int J Parasitol
(2002) Fibrosis and inflammatory cells in human chronic chagasic myocarditis: scanning electron microscopy and immunohistochemical observations
Int J Cardiol
(1998)- et al.
Correlation between Trypanosoma cruzi parasitism and myocardial inflammatory infiltrate in human chronic chagasic myocarditis: light microscopy and immunohistochemical findings
Cardiovasc Pathol
(1993)
Myocardial perfusion abnormalities in chronic Chagas' disease as detected by thallium-201 scintigraphy
Am J Cardiol
Brain natriuretic peptide and left ventricular dysfunction in Chagas' disease
Lancet
The impact of Chagas disease control in Latin America: a review
Mem Inst Oswaldo Cruz
Chagas disease: a Latin American health problem becoming a world health problem
Acta Trop
Diagnosis, management and treatment of chronic Chagas' heart disease in areas where Trypanosoma cruzi infection is not endemic
Rev Esp Cardiol
Development and validation of a risk score for predicting death in Chagas' heart disease
N Eng J Med.
Application of cardiac gated magnetic resonance imaging in murine Chagas' disease
Am J Trop Med Hyg
Magnetic resonance imaging in experimental Chagas disease: a brief review of the utility of the method for monitoring right ventricular chamber dilatation
Parasitol Res
Cited by (0)
- 1
The first two authors equally contributed to this work.