Abstract 20313: Long-Term Prognostic Value of Myocardial Fibrosis in Chagas’ Disease
Introduction: Chagas’ disease (CD) affects 5.7 million people in Latin America, with 12,500 deaths/year. Chagas’ cardiomyopathy (CC) is the main cause of death and portends poorer prognosis than other cardiomyopathies. Cardiovascular magnetic resonance (CMR) detects myocardial fibrosis (MF), a marker of disease severity in CC.
Hypothesis: We hypothesise that MF by CMR is a predictor of a composite endpoint of death from any cause, cardiac transplant, aborted sudden death and appropriated ICD therapy in long-term follow-up.
Methods: Serologically positive CD patients (pts) who had a CMR study with late gadolinium enhancement (LGE) from 2001 to 2011 were followed-up by medical records/phone calls. We excluded pts with myocardial infarction, significant CAD, valvular disease and other cardiomyopathies. Cine and LGE images were acquired in a 1.5 T scanner (GE CV/i or Philips Achieva) with standard parameters for ventricular function and MF assessment. LGE images acquired 10-20 min after 0.2mmol/kg of IV gadolinium-based contrast. MF was quantified by threshold technique (5 SD above normal myocardium) using CVi42 software (Circle CVi).
Results: We included 131 pts, 62(47%) women, mean age of 53.7±11.4 and a mean follow-up of 2182±1668 days. Fifty-eight (44.6%) pts reached the endpoint, with 51(87.9%) showing MF. MF was present in 93 (70.9%) pts, 51 (54.8%) pts reached endpoint. (p<0.001, by Chi2). Pts with MF demonstrated significantly lower survival probabilities than those without MF (p=0.0006 by log-rank test, Figure). In a multivariate Cox hazards model including MF, sex, age and LVEF, MF emerged as an independent predictor of the endpoint (HR=1.02, p=0.003).
Conclusions: Myocardial fibrosis detected by CMR in patients with Chagas’ disease was significantly and independently associated to poor long-term prognosis. This original finding may help risk-stratification of this important and neglected disease.
Author Disclosures: T. Senra: None. B. Ianni: None. C. Mady: None. M. Martinelli: None. R. Kalil Filho: None. C.E. Rochitte: None.
- © 2016 by American Heart Association, Inc.