Radionuclide Imaging in Chagas Cardiomyopathy
- 32 Downloads
Purpose of Review
To review the contributions of radionuclide imaging to understanding the manifestations and pathophysiology of chronic Chagas cardiomyopathy (CCC).
Experimental studies using high-resolution SPECT myocardial perfusion imaging (MPI) show that myocardial perfusion derangement that corresponds to dysfunctional, viable myocardium is closely linked to inflammation and precedes LV regional systolic dysfunction. Clinical studies show that microvascular ischemia is strictly related to the areas of cardiac sympathetic denervation, assessed by 123I-MIBG imaging, which correlates with severe ventricular arrhythmia incidence. Initial case reports suggest that 18F-FDG-PET imaging is a promising, non-invasive detection method for myocardial inflammation.
Available evidence indicates that microvascular ischemia participates in the mechanisms causing myocardial injury in CCC, with potential implication for monitoring subclinical disease progression. Moreover, MIBG imaging is a promising tool for risk stratification of sudden death. Preliminary clinical experience suggests a role for 18F-FDG-PET in detection of inflammation in CCC.
KeywordsChagas disease Cardiomyopathy Radionuclide imaging Scintigraphy Myocardial perfusion Myocarditis
Compliance with Ethical Standards
Conflict of Interest
Marcus Vinicius Simões, Leonardo Pippa Gadioli, and Luciano Fonseca Lemos de Oliveira declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Chagas disease in Latin America: an epidemiological update based on 2010 estimates. World Health Organization. Wkly Epidemiol Rec. 2015;90:33–43.Google Scholar
- 9.Velasco A, Morillo CA. Chagas heart disease: a contemporary review. J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1361-1.
- 11.Nunes MCP, Badano LP, Marin-Neto JA, Edvardsen T, Fernández-Golfín C, Bucciarelli-Ducci C, et al. Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian cardiovascular imaging department (DIC) and the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging. 2018;19(4):459–460n. https://doi.org/10.1093/ehjci/jex154.CrossRefPubMedGoogle Scholar
- 19.•• Lemos de Oliveira LF, Thackeray JT, Marin Neto JA, Dias Romano MM, Vieira de Carvalho EE, Mejia J, et al. Regional Myocardial Perfusion Disturbance in Experimental Chronic Chagas Cardiomyopathy. J Nucl Med. 2018;59(9):1430–6 This paper is the first to describe the findings of high-resolution SPECT perfusion and 18 F-FDG PET images in a experimental model of chronic chagas disease in hamsters, showing the correlation between myocardial perfusion disturbance and underlying inflammatory changes. CrossRefGoogle Scholar
- 20.• Tanaka DM, de Oliveira LFL, Marin-Neto JA, Romano MMD, de Carvalho EEV, de Barros Filho ACL, et al. Prolonged dipyridamole administration reduces myocardial perfusion defects in experimental chronic Chagas cardiomyopathy. J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1198-7 In this paper, the authors show the improvement of myocardial perfusion following the chronic administration of a microvascular dilator agent, reinforcing the hypothesis of participation of myocardial ischemia in the mechanism leading to cardiac dysfunction progression in CCC.
- 22.Petretta M, Cuocolo A. The long way to defeating Chagas cardiomyopathy. J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1238-3.
- 23.Köberle F. Cardiopathia parasympaticopriva. München Med Wschr. 1959;101:1308–10.Google Scholar
- 27.• Barizon GC, Simões MV, Schmidt A, Gadioli LP, Murta-Junior LO. Relationship between microvascular changes, autonomic denervation, and myocardial fibrosis in Chagas cardiomyopathy: evaluation by MRI and SPECT imaging. J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1290-z This papers describes, by employing multiple imaging modalities corregistration in patients with CCC, the close topographic and quantitative correlation among microvascular ischemia and sympathetic denervation.
- 31.•• Gadioli LP, Miranda CH, Pintya AO, de Figueiredo AB, Schmidt A, Maciel BC, et al. The severity of ventricular arrhythmia correlates with the extent of myocardial sympathetic denervation, but not with myocardial fibrosis extent in chronic Chagas cardiomyopathy: Chagas disease, denervation and arrhythmia. J Nucl Cardiol. 2018;25(1):75–83 This paper shows a quantitative correlation between the extent of sympathetic denervation and the severity of incident ventricular arrhythmia, indicating a potential role of MIBG imaging in risk stratify the risk of sudden death in CCC patients. CrossRefGoogle Scholar