Autonomic denervation, myocardial hypoperfusion and fibrosis may predict ventricular arrhythmia in the early stages of Chagas cardiomyopathy

• Published in: Journal of nuclear cardiology 2023-12, Vol.30 (6), p.2379-2388
• Main Authors: de Brito, Adriana Soares Xavier, Moll-Bernardes, Renata Junqueira, Pinheiro, Martha Valéria Tavares, Camargo, Gabriel Cordeiro, Siqueira, Fabio Paiva Rossini, Oliveira, Renee Sarmento, Glavam, Adriana Pereira, de Almeida, Sergio Altino, de Holanda, Marcelo Teixeira, Sangenis, Luiz Henrique Conde, Mendes, Fernanda de Souza Nogueira Sardinha, Rosado-de-Castro, Paulo Henrique, de Sousa, Andrea Silvestre
• Format: Article
• Language: English
• Subjects: 3-Iodobenzylguanidine; Autonomic Denervation; Cardiac arrhythmia; Cardiology; Chagas Cardiomyopathy - complications; Chagas Cardiomyopathy - diagnostic imaging; Chagas disease; Chagas Disease - complications; Chagas Disease - diagnostic imaging; Contrast Media; Coronary Artery Disease; Death, Sudden, Cardiac - prevention & control; Denervation; Fibrosis; Gadolinium; Humans; Imaging; Magnetic resonance imaging; Medicine; Medicine & Public Health; myocardial fibrosis; myocardial hypoperfusion; Myocardial Ischemia; Nuclear Medicine; Original Article; Radiology; ventricular arrhythmia; Ventricular Premature Complexes
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-023-03281-9

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. 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. 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.