Non-ischemic Primary and Secondary Cardiomyopathy
Maria-Daniela Valderrama-Achury, MD
Research Assistant
Fundación Cardioinfantil, Colombia
Héctor M. Medina, MD
Cardiac imaging
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia
Bogotá, Distrito Capital de Bogota, Colombia
Diego Rangel-Rivera, MD
Fellowship
Fundación Cardioinfantil–La Cardio, Colombia
Carlos-Eduardo Guerrero-Chalela, MD
Cardiac imaging/Adult Congenital Heart Disease
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Distrito Capital de Bogota, Colombia
Michael Chetrit, MD
Cardiac imaging
McGill University Health Center
Montreal, Canada
Eliana Vaquiro-Herrera, MSc
Epidemiologist
Fundación Cardioinfantil - Instituto de Cardiología, Distrito Capital de Bogota, Colombia
Judy Luu, MD, PhD, FSCMR
Cardiologist
Research Institute of the McGill University Health Center, Canada
Claudia-Patricia Jaimes-Castellanos, MD
Cardiac imaging
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
Julian-Francisco Forero-Melo, MD
Cardiac imaging
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
Matthias G. Friedrich, MD, FSCMR
Senior Author
Research Institute of the McGill University Health Center
Montreal, Quebec, Canada
Chagas disease is an anthropozoonosis caused by the parasite Trypanosoma cruzi (T. cruzi) that affects the heart and gastrointestinal tract. In Latin America, there are 28 million people at risk of acquiring the infection and, in Colombia, the estimated prevalence is 1-2%. Although acute cardiomyopathy has been described, most patients develop Chronic Chagas disease (CCD) characterized by recurrent myocardial inflammation and vasculitis. The assessment of CCD is done usually using trans-thoracic echocardiography. However, cardiac MRI (CMR) is considered the gold standard for ventricular volume and function and, additionally, provides unique tissue characterization, including edema and scar, which may predict adverse cardio-vascular (CV) outcomes in this population. We aim to identify key CMR findings in patients with CCD and potential predictive markers for adverse CV outcomes.
Methods:
All consecutive patients diagnosed with CCD who underwent CMR in our institution from January 2016 to April 2022 were included. Demographic and clinical variables were extracted from electronic medical records. The primary outcome of interest was death from all causes was verified in the "National Registry of Deaths of Colombia". All CMR scans were performed in a 1.5T scanner (Philips Ingenia, Amsterdam, The Netherlands) under a protocol which included SSFP, STIR, perfusion and LGE sequences.
Results:
A total of 113 patients with CCD disease were included (mean age 61.2±10.8; 54.9% female). Almost half of the patients (44%) had an LVEF ≤ 40%. The mean index end-diastolic volume was 117 (108-125) mL/m2, late gadolinium enhancement (LGE) was found in the majority of patients (96%), left ventricular (LV) edema was present in 18 % and 16% had intraventricular thrombus (Figure 1). During a mean follow-up of 2.8 years, 14 deaths were documented (a rate of 4.9% per year). CMR findings between the two groups are summarized in Table 1. Baseline characteristics were similar in both groups, differentiated only by LV size, which was significantly higher in patients who had the primary outcome than in those who survived. Patients with LV end-diastolic volume indexed volume (LVEDVI) ≥ 104 mL/m2 had worse survival than those with smaller ventricles (Figure 2).
Conclusion:
In this single-center cohort study, patients with CCD have an increased annual mortality rate of approximately 5% per year. LGE was present in almost all patients in at least one myocardial segment. Patients who experienced the primary outcome of all-cause death had increased left ventricular volumes compared to those who survived. An LVEDVI of ≥ 104 mL/m2 predicted mortality in CCD patients.