Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-01-2017 | Research

Chagas’ heart disease: gender differences in myocardial damage assessed by cardiovascular magnetic resonance

Authors: Antonildes N. Assunção Jr, Michael Jerosch-Herold, Rodrigo L. Melo, Alejandra V. Mauricio, Liliane Rocha, Jorge A. Torreão, Fabio Fernandes, Barbara M. Ianni, Charles Mady, José A. F. Ramires, Roberto Kalil-Filho, Carlos E. Rochitte

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Abstract

Background

Since a male-related higher cardiovascular morbidity and mortality in patients with Chagas’ heart disease has been reported, we aimed to investigate gender differences in myocardial damage assessed by cardiovascular magnetic resonance (CMR).

Methods and results

Retrospectively, 62 seropositive Chagas’ heart disease patients referred to CMR (1.5 T) and with low probability of having significant coronary artery disease were included in this analysis. Amongst both sexes, there was a strong negative correlation between LV ejection fraction and myocardial fibrosis (male r = 0.64, female r = 0.73, both P < 0.001), with males showing significantly greater myocardial fibrosis (P = 0.002) and lower LV ejection fraction (P < 0.001) than females. After adjustment for potential confounders, gender remained associated with myocardial dysfunction, and 53% of the effect was mediated by myocardial fibrosis (P for mediation = 0.004). Also, the transmural pattern was more prevalent among male patients (23.7 vs. 9.9%, P < 0.001) as well as the myocardial heterogeneity or gray zone (2.2 vs. 1.3 g, P = 0.003).

Conclusions

We observed gender-related differences in myocardial damage assessed by CMR in patients with Chagas’ heart disease. As myocardial fibrosis and myocardial dysfunction are associated to cardiovascular outcomes, our findings might help to understand the poorer prognosis observed in males in Chagas’ disease.

World Health Organization. Research priorities for Chagas disease, human African trypanosomiasis and leishmaniasis. World Health Organ Tech Rep Ser 2012:v–xii, 1–100.

Bern C, Montgomery SP, Herwaldt BL, Rassi A, Marin-Neto JA, Dantas RO, Maguire JH, Acquatella H, Morillo C, Kirchhoff LV, Gilman RH, Reyes PA, Salvatella R, Moore AC. Evaluation and treatment of chagas disease in the United States: a systematic review. JAMA. 2007;298:2171–81.CrossRefPubMed

Guerri-Guttenberg RA, Grana DR, Ambrosio G, Milei J. Chagas cardiomyopathy: Europe is not spared! Eur Heart J. 2008;29:2587–91.CrossRefPubMed

Bocchi EA. Heart failure in South America. Curr Cardiol Rev. 2013;9:147–56.CrossRefPubMedPubMedCentral

Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, Rassi GG, Hasslocher-Moreno A, Sousa AS, Scanavacca MI. Development and validation of a risk score for predicting death in Chagas’ heart disease. N Engl J Med. 2006;355:799–808.CrossRefPubMed

Rochitte CE, Oliveira PF, Andrade JM, Ianni BM, Parga JR, Avila LF, Kalil-Filho R, Mady C, Meneghetti JC, Lima JAC, Ramires JAF. Myocardial delayed enhancement by magnetic resonance imaging in patients with Chagas’ disease: a marker of disease severity. J Am Coll Cardiol. 2005;46:1553–8.CrossRefPubMed

Regueiro A, García-Álvarez A, Sitges M, Ortiz-Pérez JT, De Caralt MT, Pinazo MJ, Posada E, Heras M, Gascón J, Sanz G. Myocardial involvement in Chagas disease: insights from cardiac magnetic resonance. Int J Cardiol. 2013;165:107–12.CrossRefPubMed

Torreão JA, Ianni BM, Mady C, Naia E, Rassi CH, Nomura C, Parga JR, Avila LF, Ramires JAF, Kalil-Filho R, Rochitte CE. Myocardial tissue characterization in Chagas’ heart disease by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2015;17:97.CrossRefPubMedPubMedCentral

Yang Y, Chen L, Yam Y, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng VY, Chinnaiyan K, Cury R, Delago A, Dunning A, Feuchtner G, Hadamitzky M, Hausleiter J, Karlsberg RP, Kaufmann PA, Kim YJ, Leipsic J, Labounty T, Lin F, Maffei E, Raff GL, Shaw LJ, Villines TC, Min JK, Chow BJW. A Clinical model to identify patients with high-risk coronary artery disease. JACC Cardiovasc Imaging. 2015;8:427–34.CrossRefPubMed

10.

Shikanai-Yasuda MA, Carvalho NB. Oral transmission of Chagas disease. Clin Infect Dis. 2012;54:845–52.CrossRefPubMed

11.

Bastos CJC, Aras R, Mota G, Reis F, Dias JP, de Jesus RS, Freire MS, de Araújo EG, Prazeres J, Grassi MFR. Clinical outcomes of thirteen patients with acute chagas disease acquired through oral transmission from two urban outbreaks in northeastern Brazil. PLoS Negl Trop Dis. 2010;4:e711.CrossRefPubMedPubMedCentral

12.

Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Post Processing. J Cardiovasc Magn Reson. 2013;15:35. doi:10.1186/1532-429X-15-35.CrossRefPubMedPubMedCentral

13.

Perez-David E, Arenal A, Rubio-Guivernau JL, del Castillo R, Atea L, Arbelo E, Caballero E, Celorrio V, Datino T, Gonzalez-Torrecilla E, Atienza F, Ledesma-Carbayo MJ, Bermejo J, Medina A, Fernández-Avilés F. Noninvasive identification of ventricular tachycardia-related conducting channels using contrast-enhanced magnetic resonance imaging in patients with chronic myocardial infarction: comparison of signal intensity scar mapping and endocardial voltage mappin. J Am Coll Cardiol. 2011;57:184–94.CrossRefPubMed

14.

Bello D, Fieno DS, Kim RJ, Pereles FS, Passman R, Song G, Kadish AH, Goldberger JJ. Infarct morphology identifies patients with substrate for sustained ventricular tachycardia. J Am Coll Cardiol. 2005;45:1104–8.CrossRefPubMed

15.

Yan AT, Shayne AJ, Brown KA, Gupta SN, Chan CW, Luu TM, Di Carli MF, Reynolds HG, Stevenson WG, Kwong RY. Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation. 2006;114:32–9.CrossRefPubMed

16.

Baron R, Kenny D. The moderator-mediator variable distinction in social psychological research. J Pers Soc Psychol. 1986;51:1173–82.CrossRefPubMed

17.

Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol. 1982;13:290–312.CrossRef

18.

Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER, Vogel-Claussen J, Turkbey EB, Williams R, Plein S, Tee M, Eng J, Bluemke DA. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson. 2015;17:29.CrossRefPubMedPubMedCentral

19.

Sabino EC, Ribeiro AL, Salemi VMC, Di Lorenzo OC, Antunes AP, Menezes MM, Ianni BM, Nastari L, Fernandes F, Patavino GM, Sachdev V, Capuani L, de Almeida-Neto C, Carrick DM, Wright D, Kavounis K, Goncalez TT, Carneiro-Proietti AB, Custer B, Busch MP, Murphy EL. Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic Trypanosoma cruzi-Seropositive Former Blood Donors. Circulation. 2013;127:1105–15.CrossRefPubMedPubMedCentral

20.

Marin-Neto JA, Cunha-Neto E, Maciel BC, Simões MV. Pathogenesis of chronic Chagas heart disease. Circulation. 2007;115:1109–23.CrossRefPubMed

21.

Bilate AMB, Salemi VMC, Ramires FJA, de Brito T, Silva AM, Umezawa ES, Mady C, Kalil J, Cunha-Neto E. The Syrian hamster as a model for the dilated cardiomyopathy of Chagas’ disease: a quantitative echocardiographical and histopathological analysis. Microbes Infect. 2003;5:1116–24.CrossRefPubMed

22.

Higuchi ML, De Morais CF, Pereira Barreto AC, Lopes EA, Stolf N, Bellotti G, Pileggi F. The role of active myocarditis in the development of heart failure in chronic Chagas’ disease: a study based on endomyocardial biopsies. Clin Cardiol. 1987;10:665–70.CrossRefPubMed

23.

Kalil R, Bocchi EA, Ferreira BM, de Lourdes Higuchi M, Lopes NH, Magalhães AC, Mady C, Pereira Barretto AC, Albuquerque CP, Bellotti G. Magnetic resonance imaging in chronic Chagas cardiopathy. Correlation with endomyocardial biopsy findings. Arq Bras Cardiol. 1995;65:413–6. Portuguese.PubMed

24.

do Prado júnior JC, Leal Mde P, Anselmo-Franci JA, de Andrade júniur HF, Kloetzel JK. Influence of female gonadal hormones on the parasitemia of female Calomys callosus infected with the “Y” strain of Trypanosoma cruzi. Parasitol Res. 1998;84:100–5.CrossRefPubMed

25.

Schuster JP, Schaub GA. Trypanosoma cruzi: the development of estrus cycle and parasitemia in female mice maintained with or without male pheromones. Parasitol Res. 2001;87:985–93.PubMed

26.

Kubanek M, Sramko M, Maluskova J, Kautznerova D, Weichet J, Lupinek P, Vrbska J, Malek I, Kautzner J. Novel predictors of left ventricular reverse remodeling in individuals with recent-onset dilated cardiomyopathy. J Am Coll Cardiol. 2013;61:54–63.CrossRefPubMed

27.

Masci PG, Schuurman R, Andrea B, Ripoli A, Coceani M, Chiappino S, Todiere G, Srebot V, Passino C, Aquaro GD, Emdin M, Lombardi M. Myocardial fibrosis as a key determinant of left ventricular remodeling in idiopathic dilated cardiomyopathy: A contrast-enhanced cardiovascular magnetic study. Circ Cardiovasc Imaging. 2013;6:790–9.CrossRefPubMed

28.

Ambale Venkatesh B, Volpe GJ, Donekal S, Mewton N, Liu C-Y, Shea S, Liu K, Burke G, Wu C, Bluemke DA, Lima JAC. Association of longitudinal changes in left ventricular structure and function with myocardial fibrosis: the Multi-Ethnic Study of Atherosclerosis study. Hypertension. 2014;64:508–15.CrossRefPubMed

29.

Iles L, Pfluger H, Lefkovits L, Butler MJ, Kistler PM, Kaye DM, Taylor AJ. Myocardial fibrosis predicts appropriate device therapy in patients with implantable cardioverter-defibrillators for primary prevention of sudden cardiac death. J Am Coll Cardiol. 2011;57:821–8.CrossRefPubMed

30.

Neilan TG, Farhad H, Mayrhofer T, Shah RV, Dodson JA, Abbasi SA, Danik SB, Verdini DJ, Tokuda M, Tedrow UB, Jerosch-Herold M, Hoffmann U, Ghoshhajra BB, Stevenson WG, Kwong RY. Late gadolinium enhancement among survivors of sudden cardiac arrest. JACC Cardiovasc Imaging. 2015;8:414–23.CrossRefPubMedPubMedCentral

31.

Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ, Kramer CM, Salerno M. Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging. 2014;7:250–8.CrossRefPubMed

32.

de Mello RP, Szarf G, Schvartzman PR, Nakano EM, Espinosa MM, Szejnfeld D, Fernandes V, Lima JAC, Cirenza C, De Paola AAV. Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chronic Chagas’ heart disease. Arq Bras Cardiol. 2012;98:421–30.CrossRefPubMed

33.

Wu KC, Gerstenblith G, Guallar E, Marine JE, Dalal D, Cheng A, Marbán E, Lima JAC, Tomaselli GF, Weiss RG. Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death. Circ Cardiovasc Imaging. 2012;5:178–86.CrossRefPubMedPubMedCentral

34.

Hoff R, Mott KE, Silva JF, Menezes V, Hoff JN, Barrett TV, Sherlock I. Prevalence of parasitemia and seroreactivity to Trypanosoma cruzi in a rural population of Northeast Brazil. Am J Trop Med Hyg. 1979;28:461–6.PubMed

Title: Chagas’ heart disease: gender differences in myocardial damage assessed by cardiovascular magnetic resonance
Authors: Antonildes N. Assunção Jr
Michael Jerosch-Herold
Rodrigo L. Melo
Alejandra V. Mauricio
Liliane Rocha
Jorge A. Torreão
Fabio Fernandes
Barbara M. Ianni
Charles Mady
José A. F. Ramires
Roberto Kalil-Filho
Carlos E. Rochitte
Publication date: 01-01-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-016-0307-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chagas’ heart disease: gender differences in myocardial damage assessed by cardiovascular magnetic resonance

Abstract

Background

Methods and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Top 100 cited articles in cardiovascular magnetic resonance: a bibliometric analysis

Assessment of aortic stiffness by cardiovascular magnetic resonance following the treatment of severe aortic stenosis by TAVI and surgical AVR

Left and right ventricular dyssynchrony and strains from cardiovascular magnetic resonance feature tracking do not predict deterioration of ventricular function in patients with repaired tetralogy of Fallot

Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis

Antecedent hypertension and myocardial injury in patients with reperfused ST-elevation myocardial infarction

Systolic MOLLI T1 mapping with heart-rate-dependent pulse sequence sampling scheme is feasible in patients with atrial fibrillation