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

J Nucl Cardiol. 2023 Dec;30(6):2379-2388. doi: 10.1007/s12350-023-03281-9. Epub 2023 May 24.

Abstract

Background: 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.

Methods and results: 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.

Conclusion: 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.

Keywords: Chagas disease; autonomic denervation; myocardial fibrosis; myocardial hypoperfusion; ventricular arrhythmia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 3-Iodobenzylguanidine
  • Autonomic Denervation
  • Chagas Cardiomyopathy* / complications
  • Chagas Cardiomyopathy* / diagnostic imaging
  • Chagas Disease* / complications
  • Chagas Disease* / diagnostic imaging
  • Contrast Media
  • Coronary Artery Disease*
  • Death, Sudden, Cardiac / prevention & control
  • Fibrosis
  • Gadolinium
  • Humans
  • Myocardial Ischemia*
  • Ventricular Premature Complexes*

Substances

  • 3-Iodobenzylguanidine
  • Contrast Media
  • Gadolinium