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de Brito ASX, Moll-Bernardes RJ, Pinheiro MVT, Camargo GC, Siqueira FPR, Oliveira RS, Glavam AP, de Almeida SA, de Holanda MT, Sangenis LHC, Mendes FDSNS, Rosado-de-Castro PH, de Sousa AS. Autonomic denervation, myocardial hypoperfusion and fibrosis may predict ventricular arrhythmia in the early stages of Chagas cardiomyopathy. J Nucl Cardiol 2023; 30:2379-2388. [PMID: 37226005 DOI: 10.1007/s12350-023-03281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) can be the first clinical event of Chagas heart disease (CHD). However, current guidelines contain no clear recommendation for early cardioverter-defibrillator implantation. Using imaging modalities, we evaluated associations among autonomic denervation, myocardial hypoperfusion, fibrosis and ventricular arrhythmia in CHD. METHODS AND RESULTS Twenty-nine patients with CHD and preserved left ventricular function underwent 123I-metaiodobenzylguanidine (MIBG) scintigraphy, 99mTc-methoxyisobutylisonitrile (MIBI) myocardial perfusion and cardiac magnetic resonance imaging (MRI). They were divided into arrhythmic (≥ 6 ventricular premature complexes/h and/or non-sustained ventricular tachycardia on 24-hour Holter, n = 15) and non-arrhythmic (< 6 ventricular premature complexes/h and no ventricular tachycardia; n = 14) groups. The arrhythmic group had higher denervation scores from MIBG imaging (23.2 ± 18.7 vs 5.6 ± 4.9; P < .01), hypoperfusion scores from MIBI SPECT (4.7 ± 6.8 vs 0.29 ± 0.6: P = .02), innervation/perfusion mismatch scores (18.5 ± 17.5 vs 5.4 ± 4.8; P = .01) and fibrosis by late gadolinium enhancement on MRI (14.3% ± 13.5% vs 4.0% ± 2.9%; P = .04) than the non-arrhythmic group. CONCLUSION These imaging parameters were associated with ventricular arrhythmia in early CHD and may enable risk stratification and the implementation of primary preventive strategies for SCD.
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Affiliation(s)
| | | | | | - Gabriel Cordeiro Camargo
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Fabio Paiva Rossini Siqueira
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Renee Sarmento Oliveira
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Adriana Pereira Glavam
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Sergio Altino de Almeida
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Marcelo Teixeira de Holanda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Luiz Henrique Conde Sangenis
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | | | | | - Andrea Silvestre de Sousa
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil.
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
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Abstract
Hypertension is associated with atherosclerosis and cardiac and vascular structural and functional changes. Myocardial ischemia may arise in hypertension independent of coronary artery disease through an interaction between several pathophysiological mechanisms, including left ventricular hypertrophy, increased arterial stiffness and reduced coronary flow reserve associated with microvascular disease and endothelial dysfunction. The present case report demonstrates how contrast stress echocardiography can be used to diagnose myocardial ischemia in a hypertensive patient with angina pectoris but without significant obstructive coronary artery disease. The myocardial ischemia was due to severe resistant hypertension complicated with concentric left ventricular hypertrophy and increased arterial stiffness.
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Affiliation(s)
- Mai Tone Lønnebakken
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Åshild E Rieck
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Eva Gerdts
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Institute of Medicine, University of Bergen, Bergen, Norway
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