Cardiac Magnetic Resonance in the Assessment of Chagas Disease and its Complications

The well-known occurrence of Chagas disease in endemic areas has become a worldwide problem, and cardiac magnetic resonance allows the early detection of cardiac involvement and complications of this disease. Cardiac magnetic resonance is a useful tool in all phases of Chagas disease, and new promising techniques using T1 mapping and extracellular volume measurements are able to detect cardiac involvement even earlier than conventional techniques.

Keywords
Chagas Diseases/complications; Chagas Cardiomyopathy/complications; Fibrosis; Heart Failure; Magnetic Resonance Imaging/methods; Gadolinium /radiation effects; Extracellular Volume; T1 Mapping; Endemic Diseases

Authorship

Ariane Binoti Pacheco

Multiscan Inteligência Diagnóstica, Vitória, ES - BrazilMultiscan Inteligência DiagnósticaBrazilVitória, ES, BrazilMultiscan Inteligência Diagnóstica, Vitória, ES - Brazil

Universidade de São Paulo, São Paulo, SP - BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilUniversidade de São Paulo, São Paulo, SP - Brazil

https://orcid.org/0000-0001-7006-7348

Rodrigo de Jesus Louzeiro Melo

Universidade de São Paulo, São Paulo, SP - BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilUniversidade de São Paulo, São Paulo, SP - Brazil

https://orcid.org/0000-0002-2884-1712

Carlos Eduardo Rochitte Mailing Address: Carlos Eduardo Rochitte, Departamento de Imagem Cardiovascular, Universidade de São Paulo, Instituto do Coração do HCFMUSP Av. Dr. Enéas Carvalho de Aguiar, 44. Postal Code: 05403-900, Cerqueira César, São Paulo, SP - Brazil.

Universidade de São Paulo, São Paulo, SP - BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilUniversidade de São Paulo, São Paulo, SP - Brazil

https://orcid.org/0000-0003-4505-3344

Mailing Address: Carlos Eduardo Rochitte, Departamento de Imagem Cardiovascular, Universidade de São Paulo, Instituto do Coração do HCFMUSP Av. Dr. Enéas Carvalho de Aguiar, 44. Postal Code: 05403-900, Cerqueira César, São Paulo, SP - Brazil.

Author contributions

Conception and design of the research: Pacheco AB. Rochitte CE. Acquisition of data: Pacheco AB, Melo, RJL. Analysis and interpretation of the data: Pacheco AB, Rochitte, CE. Writing of the manuscript: Pacheco AB, Melo, RJL. Critical revision of the manuscript for intellectual content: Rochitte CE.

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

SCIMAGO INSTITUTIONS RANKINGS

Multiscan Inteligência Diagnóstica, Vitória, ES - BrazilMultiscan Inteligência DiagnósticaBrazilVitória, ES, BrazilMultiscan Inteligência Diagnóstica, Vitória, ES - Brazil

Universidade de São Paulo, São Paulo, SP - BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilUniversidade de São Paulo, São Paulo, SP - Brazil

Figures

Figures (6)

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Figure 1
Example of acute Chagas disease. In a, T2-weighted edema imaging demonstrating area of signal hyperintensity in the LV basal inferoseptal segment (short axis view) corresponding myocardial edema (arrow). In b and c, LGE imaging revels area of myocardial necrosis/fibrosis in the same region (arrow).

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Figure 2
A 50-year-old man present isolated RV involvement secondary to chronic Chagas disease easily detected by cine-CMR sequence.

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Figure 3
Examples of complications of chronic Chagas disease in two representative patients. First patient: (a-b) cine-CMR reveals typical ventricular apical aneurysm (vorticilar) (arrows). Second patient: (c) LGE-CMR reveals apical thrombus (arrow) and LV myocardial fibrosis.

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Figure 4
LGE-CMR showing classic cardiac involvement in chronic Chagas disease (arrows). In a-e, midwall and subepicardial myocardial fibrosis in the LV inferolateral regions (short axis view). In f, myocardial fibrosis in the LV apex (three-chamber view).

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Figure 5
An 83-year-old woman with positive serological tests for Chagas disease and atypical LGE that simulates transmural infarction. In a and b, myocardial fibrosis in the circumflex artery territory (lateral wall - arrows). In c, coronary angiography showing absence of coronary artery disease.

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Figure 6
Examples of LGE, extracellular volume, native and post-contrast T1 mid-cavity short axis images in patients with indeterminate form (a, b, c, and d, respectively) and with reduced LV ejection fraction (e, f, g, and h, respectively). In the indeterminate form, we note homogeneous myocardial signal in all sequences, showing no interstitial enlargement. In the Chronic Chagas cardiomyopathy, we see LGE in inferolateral wall, interventricular septum and myocardial junctions; in T1 mapping and extracellular volume sequences, those alterations are more pronounced, showing interstitial fibrosis in LGE-negative areas, as anterolateral and inferior walls.

Figure 1 Example of acute Chagas disease. In a, T2-weighted edema imaging demonstrating area of signal hyperintensity in the LV basal inferoseptal segment (short axis view) corresponding myocardial edema (arrow). In b and c, LGE imaging revels area of myocardial necrosis/fibrosis in the same region (arrow).

Figure 2 A 50-year-old man present isolated RV involvement secondary to chronic Chagas disease easily detected by cine-CMR sequence.

Figure 3 Examples of complications of chronic Chagas disease in two representative patients. First patient: (a-b) cine-CMR reveals typical ventricular apical aneurysm (vorticilar) (arrows). Second patient: (c) LGE-CMR reveals apical thrombus (arrow) and LV myocardial fibrosis.

Figure 4 LGE-CMR showing classic cardiac involvement in chronic Chagas disease (arrows). In a-e, midwall and subepicardial myocardial fibrosis in the LV inferolateral regions (short axis view). In f, myocardial fibrosis in the LV apex (three-chamber view).

Figure 5 An 83-year-old woman with positive serological tests for Chagas disease and atypical LGE that simulates transmural infarction. In a and b, myocardial fibrosis in the circumflex artery territory (lateral wall - arrows). In c, coronary angiography showing absence of coronary artery disease.

Figure 6 Examples of LGE, extracellular volume, native and post-contrast T1 mid-cavity short axis images in patients with indeterminate form (a, b, c, and d, respectively) and with reduced LV ejection fraction (e, f, g, and h, respectively). In the indeterminate form, we note homogeneous myocardial signal in all sequences, showing no interstitial enlargement. In the Chronic Chagas cardiomyopathy, we see LGE in inferolateral wall, interventricular septum and myocardial junctions; in T1 mapping and extracellular volume sequences, those alterations are more pronounced, showing interstitial fibrosis in LGE-negative areas, as anterolateral and inferior walls.

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Cardiac Magnetic Resonance in the Assessment of Chagas Disease and its Complications

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[1] Mailing Address: Carlos Eduardo Rochitte, Departamento de Imagem Cardiovascular, Universidade de São Paulo, Instituto do Coração do HCFMUSP Av. Dr. Enéas Carvalho de Aguiar, 44. Postal Code: 05403-900, Cerqueira César, São Paulo, SP - Brazil.