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Cardiac magnetic resonance imaging in Chagas’ disease: a parallel with electrophysiologic studies

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Abstract

Chagas’ disease (CD), caused by the parasite Trypanosoma cruzi, is the leading cause of cardiac disability from infectious diseases in Central and South America. The disease progresses through an extended, asymptomatic form characterized by latency without clinical manifestations into a symptomatic form with cardiac and gastro-intestinal manifestations. In the terminal phase, chronic Chagas’ myocarditis results in extensive myocardial fibrosis, chamber enlargement with aneurysms and ventricular tachycardia (VT). Cardiac magnetic resonance imaging (CMR) has proven useful in characterizing myocardial fibrosis (MF). Sub-epicardial and mid-wall fibrosis are less common patterns of MF in CHD than transmural scar, which resembles myocardial infarction. Commonly involved areas of MF include the left ventricular apex and basal infero-lateral wall, suggesting a role for watershed ischemia in the pathophysiology of MF. Electrophysiology studies have helped refine the relationship between MF and VT in this setting. This article reviews the patterns of MF in CHD and correlate these patterns with electrogram patterns to predict risk of ventricular arrhythmias and sudden death.

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  1. Internal Medicine Residency Program, Cleveland Clinic Foundation, Cleveland, OH, USA

    Alejandro Duran-Crane

  2. Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, FL, USA

    Carlos A. Rojas

  3. Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA

    Leslie T. Cooper

  4. Department of Cardiovascular Imaging, Fundación Cardioinfantil, Calle 163a #13B-60, 110131, Bogotá, Colombia

    Hector M. Medina

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  1. Alejandro Duran-Crane
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Duran-Crane, A., Rojas, C.A., Cooper, L.T. et al. Cardiac magnetic resonance imaging in Chagas’ disease: a parallel with electrophysiologic studies. Int J Cardiovasc Imaging 36, 2209–2219 (2020). https://doi.org/10.1007/s10554-020-01925-2

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