Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification

Chagas disease (CD) will account for 200,000 cardiovascular deaths worldwide over the next 5 years. Early detection of chronic Chagas cardiomyopathy (CCC) is a challenge. We aimed to test if speckle-tracking echocardiography (STE) can detect incipient myocardial damage in CD. METHODS: Among 325 individuals with positive serological tests, 25 (age 55±12yrs) were selected to compose the group with indeterminate form of Chagas disease (IFCD), based on stringent criteria of being asymptomatic and with normal EKG/X-ray studies. This group was compared with a group of 20 patients with CCC (55±11yrs) and a group of 20 non-infected matched control (NC) subjects (48±10yrs). CD patients and NC were submitted to STE and CD patients were submitted to cardiac magnetic resonance (CMR) with late gadolinium administration to detect cardiac fibrosis by the late enhancement technique. Global longitudinal strain (GLS), circumferential (GCS) and radial strain (GRS) were defined as the average of segments measured from three apical view (GLS) and short axis views (GRS and GCS). Regional left ventricular (LV) longitudinal strain (Reg LS) was measured from each of the 17 segments. Twist was measured as systolic peak difference between basal and apical rotation and indexed to LV length to express torsion. RESULTS: STE global indices (GLS, GCS, twist and torsion) were reduced in CCC vs NC (GLS: -14±6.3% vs -19.3±1.6%, p = 0.001; GCS: -13.6±5.2% vs -17.3 ±2.8%; p = 0.008; twist: 8±7° vs 14±7°, p = 0.01 and torsion: 0.96±1°/cm vs 1.9±1°/cm, p = 0.005), but showed no differences in IFCD vs NC. RegLS was reduced in IFCD vs NC in four LV segments: basal-inferior (-16.3±3.3% vs -18.6±2.2%, p = 0.013), basal inferoseptal (-13.1±3.4 vs -15.2±2.7, p = 0.019), mid-inferoseptal (-17.7±3.2 vs -19.4±2, p = 0.032) and mid-inferolateral (-15.2±3.5 vs -17.8±2.8, p = 0.014). These abnormalities in RegLS occurred in the absence of myocardial fibrosis detectable with CMR in nearly 92% of subjects with IFCD, while myocardial fibrosis was present in 65% with CCC. CONCLUSION: RegLS detects early regional impairment of myocardial strain that is independent from fibrosis in IFCD subjects.

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CARDIAC MAGNETIC RESONANCE IN THE EVALUATION OF FIBROSIS IN CHAGAS’ DISEASE

Brazilian Journal of Medicine and Human Health ◽

10.17267/2317-3386bjmhh.v2i2.422 ◽

2014 ◽

Vol 2 (2) ◽

Author(s):

Polyana Evangelista Lima ◽

André Maurício Fernandes ◽

Marta Menezes ◽

Edmundo J. N. Câmara ◽

Roque Aras Júnior

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

Chagas Disease ◽

High Sensitivity ◽

Cardiac Inflammation ◽

Pubmed Database ◽

Important Diagnostic Tool ◽

Prognostic Stratification ◽

Chagasic Cardiomyopathy

Introduction: Chagas’ disease (CD) is the leading cause of heart failure in endemic regions. Although its pathogenesis is not clearly defined, the cardiac form is characterized by chronic inflammation and myocardial fibrosis (MF). The Cardiac Magnetic Resonance (CMR) is the gold standard noninvasive method for analysis of MF through the myocardial delayed enhancement technique (MDE). Objective: To evaluate the use of CMR in patients with CD, with emphasis on evaluation of myocardial fibrosis and inflammation. Method: Study of literature review, developed from the electronic PUBMED database using the descriptors: “cardiac magnetic resonance”, “chagas disease” from January 1993 to June 2014. Results: Of the 62 articles found, 10 were selected. Three of these studies compared CMR with endomyocardial biopsy and failed to demonstrate a high sensitivity of CMR for detecting MF. Recently, some authors have been investigating MF and cardiac inflammation with CMR in Chagas’ disease, and were able to establish the CMR as an important tool for prognostic stratification of patients withchronic chagasic cardiomyopathy (CCC). Conclusions: CMR is an important diagnostic tool in cardiac involvement in CD, allowing more precise stratification of its severity stages.

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Prevalence, distribution and clinical correlates of myocardial fibrosis in systemic lupus erythematosus: a cardiac magnetic resonance study

Lupus ◽

10.1177/0961203315622275 ◽

2015 ◽

Vol 25 (6) ◽

pp. 573-581 ◽

Cited By ~ 14

Author(s):

M G Seneviratne ◽

S M Grieve ◽

G A Figtree ◽

R Garsia ◽

D S Celermajer ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

Lupus Erythematosus ◽

Magnetic Resonance Study ◽

Systemic Lupus ◽

Clinical Correlates ◽

Cardiac Magnetic Resonance Study

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Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02165-8 ◽

2021 ◽

Author(s):

Zsofia Dohy ◽

Liliana Szabo ◽

Attila Toth ◽

Csilla Czimbalmos ◽

Rebeka Horvath ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Hypertrophic Cardiomyopathy ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

Ventricular Arrhythmias ◽

Prognostic Significance ◽

Strain Analysis ◽

Left Ventricular ◽

Icd Therapy ◽

Lv Mass

AbstractThe prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.

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Diffuse myocardial fibrosis evaluation using cardiac magnetic resonance T1 mapping: sample size considerations for clinical trials

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-14-90 ◽

2012 ◽

Vol 14 (1) ◽

pp. 90 ◽

Cited By ~ 70

Author(s):

Songtao Liu ◽

Jing Han ◽

Marcelo S Nacif ◽

Jacquin Jones ◽

Nadine Kawel ◽

...

Keyword(s):

Clinical Trials ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Sample Size ◽

Myocardial Fibrosis ◽

T1 Mapping ◽

Diffuse Myocardial Fibrosis

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Proteoglycan remodeling is accelerated in women with angina pectoris and diffuse myocardial fibrosis: the iPOWER Study

European Heart Journal ◽

10.1093/ehjci/ehaa946.1280 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N.D Mygind ◽

S Holm Nielsen ◽

M Mide Michelsen ◽

A Pena ◽

D Bechsgaard Frestad ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Angina Pectoris ◽

Myocardial Fibrosis ◽

T1 Mapping ◽

Obstructive Coronary Artery Disease ◽

Extracellular Volume ◽

Diffuse Myocardial Fibrosis ◽

Public Institution ◽

Funding Source

Abstract Background Women with angina and no obstructive coronary artery disease (CAD) have an unfavourable prognosis, possibly due to coronary microvascular disease and diffuse myocardial fibrosis (DMF). In DMF myocardial extracellular matrix (ECM) proteins are actively remodeled by matrix metalloproteinase (MMP). Purpose We investigated MMP-mediated degradation of the protegoglycans biglycan and versican in women with angina pectoris and possible DMF assessed by cardiac magnetic resonance T1 mapping. Methods Seventy-one women with angina pectoris and no obstructive CAD were included. Asymptomatic age-matched women served as controls (n=32). Versican and biglycan were measured in serum by specific competitive enzyme-linked immunosorbent assays. T1 mapping was performed by cardiac magnetic resonance with gadolinium measuring T1 and extracellular volume (ECV). Results Both biglycan and versican levels were higher in symptomatic women compared with controls; 31.4 ng/mL vs. 16.4 ng/mL (p<0.001) and 2.1 ng/mL vs. 1.8 ng/mL (p<0.001), respectively (Figure 1) and were moderately correlated to global ECV (r2=0.38, p<0.001 and r2=0.26, p=0.015 respectively). Conclusion Turnover of biglycan and versican was increased in symptomatic compared to asymptomatic women and associated to ECV, supporting a link between angina with no obstructive CAD and fibrotic cardiac remodeling. The examined biomarkers may prove to be suitable for monitoring active ECM remodeling. Figure 1. Levels of BGM and VCANM Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): This work was supported by The Danish Heart Foundation, the Danish Research Fund (Den Danske Forskningsfond) and by University of Copenhagen.

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Abstract 10378: Characterization of Changes in Cardiac Structure and Function in Mice Treated With Anthracyclines Using Serial Cardiac Magnetic Resonance Imaging

Circulation ◽

10.1161/circ.132.suppl_3.10378 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Pedro V Staziaki ◽

Hoshang Farhad ◽

Otávio Coelho-Filho ◽

Ravi V Shah ◽

Richard N Mitchell ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

Myocardial Edema ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Post Contrast ◽

Cardiac Edema ◽

Early Increase ◽

Acute Increase

Introduction: Anthracyclines are a standard chemotherapeutic agent. However, the anthracyclines are associated with a late reduction in left ventricular ejection fraction (LVEF) and heart failure. Pathologically, anthracycline-induced cardiotoxicity (AIC) is characterized by the development of cardiac edema and fibrosis and cardiac magnetic resonance (CMR) is the gold-standard imaging technique for edema and fibrosis. Hypothesis: We hypothesized that a) cardiac edema and fibrosis would be detected by CMR after anthracyclines and b) edema and fibrosis would provide prognostic information. Methods: We performed a longitudinal CMR and histological study of 45 wild-type mice randomized to doxorubicin (DOX, n=30, 5 mg/kg/week for 5 weeks) or placebo (n=15). Measurements were performed at baseline, 5, 10, and 20 weeks after DOX or placebo. Measures of interest were LVEF, myocardial edema and fibrosis. Edema was assessed by T2 mapping, fibrosis by calculating the extracellular volume (ECV) from pre- and post-contrast T1 measurements. Results: In DOX-treated mice vs. placebo, myocardial edema at 5 weeks was increased (T2 values of 32±4 vs. 21±3 ms, P<0.05, Fig. A), while LVEF was unchanged. At 10 weeks, there was a reduction in LVEF (54±6 vs. 63±5% μL, P<0.05) and an increase in myocardial fibrosis (ECV of 0.34±0.03 vs. 0.27±0.03, P<0.05, Fig. B). There was a correlation between T2 measures and cardiac water weight (r=0.79, P=0.007, Fig. C) and between the ECV and histological myocardial fibrosis (r=0.90, P<0.001; Fig. D). Both the early increase in edema and the sub-acute increase in fibrosis predicted the late DOX-induced mortality (P<0.001, Fig. E and F). Conclusions: Our data suggest that, in mice, CMR can detect the early increase in edema and sub-acute increase in fibrosis after anthracyclines, that an increase in edema precedes a reduction in LVEF, that the increase in edema and fibrosis are linked and both are predictive of late animal mortality.

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