Diffuse Myocardial Fibrosis and Cardiomyocyte Diameter Are Associated With Heart Failure Symptoms in Chagas Cardiomyopathy

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Gemme, Cristiane Nardi ; Silva, Thiago Quinaglia A. C. ; Martins, Luiz C. ; da Silva, Luis Miguel ; Paim, Layde Rosane ; Sposito, Andrei ; Nadruz, Wilson ; Fernandes, Fabio ; Dertkigil, Sergio San Juan ; Wanderley, Jamiro da Silva ; de Almeida, Eros A. ; Metze, Konradin ; Neilan, Tomas G. ; Jerosch-Herold, Michael ; Coelho-Filho, Otavio R.

• Document type: Journal article
• Source: FRONTIERS IN CARDIOVASCULAR MEDICINE; v. 9, p. 12-pg., 2022-06-17.

Abstract

Background: Chronic Chagas cardiomyopathy (CCC) constitutes the most life-threatening consequence of the Trypanosoma cruzi infection. Our goal was to test in CCC the associations of the myocardial tissue phenotype with cardiac dysfunction, and heart failure (HF) severity, using cardiac magnetic resonance (CMR). Methods: We performed a prospective observational cohort of patients with consecutive CCC with a CMR protocol, including ventricular function, myocardial T1, and late gadolinium enhancement (LGE). Extracellular volume (ECV), and intracellular water lifetime, tau(iC), a measure of cardiomyocyte diameter, were compared to CCC disease progression, including Rassi score and New York Heart Association (NYHA) class. An exploratory prognostic analysis was performed to investigate the association of both ECV and tau(iC) with CV death. Results: A total of 37 patients with intermediate-to-high-risk CCC were enrolled (Chagas Rassi score >= 7, mean left ventricle (LV) ejection fraction (EF) 32 +/- 16%). Myocardial ECV (0.40 +/- 0.07) was correlated with Rassi score (r = 0.43; P = 0.009), higher NYHA class, and LV EF (r = -0.51; P = 0.0015). tau(iC) decreased linearly with NYHA class (P = 0.007 for non-parametric test of linear trend) and showed a positive association with LV EF (r = 0.47; P = 0.004). Over a median follow-up of 734 days (range: 6-2,943 days), CV death or cardiac transplantation occurred in 10 patients. The Rassi score (heart rate [HR] = 1.3; 95% CI = [1.0, 1.8]; P = 0.028) and ECV (HR = 3.4 for 0.1 change, 95% Cl = [1.1, 11.0], P = 0.039) were simultaneously associated with CV death. Conclusion: In patients with intermediate-to-high-risk CCC, an expanded ECV and regression of cardiomyocyte diameter were associated with worsening systolic function and HF severity, respectively. The exploratory analysis indicates that ECV may have a prognostic value to identify patients with CCC at a higher risk for cardiovascular events. (AU)

• FAPESP's process: 15/15402-2 - Characterization of interstitial fibrosis and cardiomyocyte hypertrophy by cardiac MRI: implication on early remodeling and on the transition to heart failure
• Grantee: Otávio Rizzi Coelho-Filho
• Support Opportunities: Research Grants - Young Investigators Grants
• FAPESP's process: 16/26209-1 - Multi-user equipament approved in grat 2015/15402-2: cardiorespiratory diagnostic system
• Grantee: Otávio Rizzi Coelho-Filho
• Support Opportunities: Multi-user Equipment Program
• FAPESP's process: 17/03708-5 - Multi-user equipament approved in the grant 2015/15402-2: ecocardiograma
• Grantee: Otávio Rizzi Coelho-Filho
• Support Opportunities: Multi-user Equipment Program