PMID- 30466514 OWN - NLM STAT- MEDLINE DCOM- 20190912 LR - 20190912 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 72 IP - 21 DP - 2018 Nov 27 TI - Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy. PG - 2567-2576 LID - S0735-1097(18)38657-1 [pii] LID - 10.1016/j.jacc.2018.09.035 [doi] AB - BACKGROUND: Patients with chronic Chagas cardiomyopathy (CCC) have pronounced myocardial fibrosis, which may predispose to sudden cardiac death, despite well-preserved global left ventricular (LV) systolic function. Cardiac magnetic resonance can assess myocardial fibrosis by late gadolinium enhancement (LGE) sequences. OBJECTIVES: This prospective study evaluated if the presence of scar by LGE predicted hard adverse outcomes in a cohort of patients with CCC. METHODS: A prospective cohort of 140 patients with CCC (52.1% female; median age 57 years [interquartile range: 45 to 67 years]) were included. Cardiac magnetic resonance cine and LGE imaging were performed at enrollment with a 1.5-T scanner. The primary endpoint was the combination of cardiovascular death and sustained ventricular tachycardia. The secondary endpoint was the combination of cardiovascular death, sustained ventricular tachycardia, or cardiovascular hospitalization during follow-up. RESULTS: After a median of 34 months (interquartile range: 24 to 49 months) of follow-up, 11 cardiovascular deaths, 3 episodes of sustained ventricular tachycardia, and 20 cardiovascular hospitalizations were recorded. LGE scar was present in 71.4% of the patients, with the lateral, inferolateral, and inferior walls most commonly affected. Patients with positive LGE had lower LV ejection fraction and higher LV end-diastolic volume and LV mass than patients without LGE. No difference in other cardiovascular risk factors was noted. Patients with scar had higher event rates compared with those without scar for the primary (p = 0.043) and the secondary (p = 0.016) endpoint. In multivariable analysis, age and LGE area were related to primary outcome; age and lower LV ejection fraction were related to the secondary outcome. The pattern of LGE myocardial fibrosis was transmural, focal, or diffuse scar in approximately one-third of patients with positive LGE, and no pattern was specifically related to outcomes. CONCLUSIONS: In patients with CCC, presence of scar by LGE is common and is strongly associated with major adverse outcomes. CI - Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Volpe, Gustavo J AU - Volpe GJ AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Moreira, Henrique T AU - Moreira HT AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Trad, Henrique S AU - Trad HS AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Wu, Katherine C AU - Wu KC AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Braggion-Santos, Maria Fernanda AU - Braggion-Santos MF AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Santos, Marcel K AU - Santos MK AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Maciel, Benedito C AU - Maciel BC AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Pazin-Filho, Antonio AU - Pazin-Filho A AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Marin-Neto, Jose Antonio AU - Marin-Neto JA AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. FAU - Lima, Joao A C AU - Lima JAC AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Schmidt, Andre AU - Schmidt A AD - Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. Electronic address: aschmidt@fmrp.usp.br. LA - eng PT - Journal Article PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - IM CIN - J Am Coll Cardiol. 2018 Nov 27;72(21):2588-2590. PMID: 30466516 MH - Adult MH - Aged MH - Chagas Cardiomyopathy/*diagnostic imaging/*mortality MH - Chronic Disease MH - Cicatrix/*diagnostic imaging/*mortality MH - Cohort Studies MH - Electrocardiography/trends MH - Female MH - Follow-Up Studies MH - Heart Ventricles/*diagnostic imaging MH - Humans MH - Magnetic Resonance Imaging, Cine/trends MH - Male MH - Middle Aged MH - Mortality/trends MH - Prognosis MH - Prospective Studies OTO - NOTNLM OT - Chagas OT - Chagas heart disease OT - MRI OT - clinical events OT - late gadolinium enhancement OT - scar EDAT- 2018/11/24 06:00 MHDA- 2019/09/13 06:00 CRDT- 2018/11/24 06:00 PHST- 2018/03/12 00:00 [received] PHST- 2018/09/12 00:00 [revised] PHST- 2018/09/18 00:00 [accepted] PHST- 2018/11/24 06:00 [entrez] PHST- 2018/11/24 06:00 [pubmed] PHST- 2019/09/13 06:00 [medline] AID - S0735-1097(18)38657-1 [pii] AID - 10.1016/j.jacc.2018.09.035 [doi] PST - ppublish SO - J Am Coll Cardiol. 2018 Nov 27;72(21):2567-2576. doi: 10.1016/j.jacc.2018.09.035.