1. Relationship between Fibrosis and Ventricular Arrhythmias in Chagas Heart Disease Without Ventricular Dysfunction
- Author
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Emilia Matos do Nascimento, Basilio de Bragança Pereira, Marcelo Abramoff Continentino, Roberto Coury Pedrosa, and Eduardo Marinho Tassi
- Subjects
Tachycardia ,Chagas disease ,Male ,medicine.medical_specialty ,Chagas Heart Disease ,Time Factors ,Heart disease ,Arrhythmias ,Statistics, Nonparametric ,Ventricular Function, Left ,Body Mass Index ,Electrocardiography ,Fibrosis ,Predictive Value of Tests ,Reference Values ,Internal medicine ,Ventricular Dysfunction ,Medicine ,Humans ,Chagas Disease ,cardiovascular diseases ,Aged ,Observer Variation ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Stroke Volume ,Original Articles ,Myocardial Fibrosis ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Predictive value of tests ,Cardiology ,cardiovascular system ,Exercise Test ,Tachycardia, Ventricular ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Cardiac ,circulatory and respiratory physiology - Abstract
Background: Patients 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. Objective: To 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. Methods: Electrocardiogram, 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. Results: The 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). Conclusion: Even 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.
- Published
- 2014