Abstract 15088: Scar Pattern in Chagas Heart Disease
Introduction: Scar in Chagas heart disease (CHD) is thought to be predominantly epicardial and requires epicardial access for ventricular tachycardia (VT) ablation. However, little data exists on scar patterns in this population. We evaluated the patterns of scar in patients who underwent magnetic resonance imaging (MRI) with delayed enhancement (DE).
Methods: 19 patients were enrolled who had evidence of DE by MRI: 4 (21.0%) patients with normal electrocardiogram (ECG) and normal echocardiogram (echo) (group 1); 3 (15.8%) patients with abnormal ECG and normal echo (group 2); and 12 (63.2%) patients with abnormal ECG and echo (group 3).
Results: In the 19 patients, there were 110 segments (34.1%) with DE identified using a 17-segment model. Pattern of involvement is as follows: endocardial 30 (27.3%), mid-myocardial 22 (20.0%), epicardial 2 (1.8%) and transmural 56 (50.9%). Most common territories of involvement are as follows (% of patients with segment involved): Basal inferolateral (78.9%), basal anterolateral (68.4%), mid inferolateral (63.2%), mid anterolateral (52.6%), apical lateral (52.6%) and apex (42.1%).
The pattern of involvement also varied by group. In group 1, mid-myocardial 7 (50%), endocardial 6 (42.9%), transmural 1 (7.1%). In group 2, mid-myocardial 2 (18.2%), endocardial 6 (54.5%), transmural 3 (27.3%). In group 3, mid-myocardial 13 (15.3%), endocardial 18 (21.2%), transmural 52 (61.2%), epicardial 2 (2.4%).
Conclusion: DE tends to occur most commonly in the basal and mid lateral segments. At earlier stages of disease, myocardial scar pattern tends to involve mid-myocardium and endocardium, and progress to transmural in later stages. Isolated epicardial scar was rare in this patient population, which is has potential implications for VT ablation strategies.
Author Disclosures: M.I. Traina: None. M. Thomas: None. J. Bradfield: None. S. Hernandez: None. A.J. Altamirano Ufion: None. D.R. Sanchez: None. S.K. Meymandi: None.
- © 2014 by American Heart Association, Inc.