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01-02-2018 | Original Article

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

Authors: Leonardo Pippa Gadioli, MD, PhD, Carlos Henrique Miranda, MD, PhD, Antonio Osvaldo Pintya, MD, PhD, Alexandre Baldini de Figueiredo, MD, André Schmidt, MD, PhD, Benedito Carlos Maciel, MD, PhD, José Antonio Marin-Neto, MD, PhD, Marcus Vinicius Simões, MD, PhD

Published in: Journal of Nuclear Cardiology | Issue 1/2018

Abstract

Background

To investigate the correlation between the extent of myocardial sympathetic denervation and fibrosis and the presence of degrees of severity of ventricular arrhythmias in chronic Chagas cardiomyopathy (CCC).

Methods

Forty-three CCC patients with left ventricular ejection fraction (LVEF) ≥ 35% were divided into three groups: SVT group—presenting Sustained Ventricular Tachycardia (SVT) (n = 15), NSVT group—exhibiting episodes of non-SVT (NSVT) on 24-h Holter monitoring (n = 11), and Control group—exhibiting neither SVT nor episodes of NSVT (n = 17). The patients underwent SPECT imaging for myocardial sympathetic innervation with ¹²³Iodine-MIBG (MIBG) and myocardial perfusion with ^99mTc-Sestamibi (MIBI) for the evaluation of regional myocardial fibrosis.

Results

The summed rest perfusion scores were similar in the three groups. The summed difference score between MIBG and MPI images, which evaluated the extent of denervated but viable myocardium, was significantly higher in SVT group (20.0 ± 8.0) as compared with the control group (2.0 ± 5.0, P < .0001) and with the NSVT group (11.0 ± 8.0, P < .05).

Conclusions

The occurrence of ventricular arrhythmias of different degrees of severity correlates quantitatively with the extent of cardiac sympathetic denervation, but not with the extent of fibrosis, suggesting that myocardial sympathetic denervation plays a major role in triggering ventricular arrhythmia in CCC.

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Title: 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
Authors: Leonardo Pippa Gadioli, MD, PhD
Carlos Henrique Miranda, MD, PhD
Antonio Osvaldo Pintya, MD, PhD
Alexandre Baldini de Figueiredo, MD
André Schmidt, MD, PhD
Benedito Carlos Maciel, MD, PhD
José Antonio Marin-Neto, MD, PhD
Marcus Vinicius Simões, MD, PhD
Publication date: 01-02-2018
Publisher: Springer US
Published in: Journal of Nuclear Cardiology / Issue 1/2018
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-016-0556-6

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Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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