BackgroundPatients with Chagas disease and segmental wall motion abnormality (SWMA) have
worse prognosis independent of left ventricular ejection fraction (LVEF). Cardiac
magnetic resonance (CMR) is currently the best method to detect SWMA and to assess
fibrosis.ObjectiveTo quantify fibrosis by using late gadolinium enhancement CMR in patients with
Chagas disease and preserved or minimally impaired ventricular function (>
45%), and to detect patterns of dependence between fibrosis, SWMA and LVEF in the
presence of ventricular arrhythmia.MethodsElectrocardiogram, treadmill exercise test, Holter and CMR were carried out in 61
patients, who were divided into three groups as follows: (1) normal
electrocardiogram and CMR without SWMA; (2) abnormal electrocardiogram and CMR
without SWMA; (3) CMR with SWMA independently of electrocardiogram.ResultsThe number of patients with ventricular arrhythmia in relation to the total of
patients, the percentage of fibrosis, and the LVEF were, respectively: Group 1,
4/26, 0.74% and 74.34%; Group 2, 4/16, 3.96% and 68.5%; and Group 3, 11/19, 14.07%
and 55.59%. Ventricular arrhythmia was found in 31.1% of the patients. Those with
and without ventricular arrhythmia had mean LVEF of 59.87% and 70.18%,
respectively, and fibrosis percentage of 11.03% and 3.01%, respectively. Of the
variables SWMA, groups, age, LVEF and fibrosis, only the latter was significant
for the presence of ventricular arrhythmia, with a cutoff point of 11.78% for
fibrosis mass (p < 0.001).ConclusionEven in patients with Chagas disease and preserved or minimally impaired
ventricular function, electrical instability can be present. Regarding the
presence of ventricular arrhythmia, fibrosis is the most important variable, its
amount being proportional to the complexity of the groups.
