Use and characterization of myocardial fibrosis assessed by CMR and 3D reconstruction in Chagas disease as a predictor of ventricular arrhythmias

SERRA L; LO PRESTI MS; PAGLINI P; MERSCHON F; RIVAROLA HW; FREGAPANI J; BLASCO R; CATALFAMO D

Buenos Aires

Congreso; 16th World Congress of Arrhythmias; 2019

Sociedad Argentina de Electrofisiología Cardíaca y World Society of Arrhythmias

INTRODUCTION: Chagas disease is caused by a parasite infection Trypanosoma Cruzi endemic inAmerica By the way, is the most frequent manifestation of the chronic phase of this disease, presenting as heart failure ventricular arrhthymias differents types of blocks embolic phenomen and sudden death Current imaging techniques such as magnetic cardiac resonance are able to identify or detect myocardial fibrosis at an early stage before the development of symptoms Conducting channels CC) could be identified with contrast enhanced cardiac magnetic resonance ce CMR) A 3 dimensional 3 D) reconstruction of the ce CMR could allow visualization of the 3 D structure of these CC.OBJECTIVES: The objective of this study was to evaluate in Chagas disease the myocardial fibrosis using 3 D cardiac magnetic resonance imaging MRI with special sequence and analysis of the same with software fot automatic detection of arrhythmogenic substrate fibrosis and slow conduction channels), in order to determine ifthis factor can predict the occurrence of ventricular events.METHODS: 1) We selected patients with positive serology for Chagas Disease. 2) Cardiomyopathy without ventricular arrhthymias,syncope or implantable cardiac device (PM or ICD), 3D LGE cardiac MRI performed on Siemens Magnetom Spectra 3T. 3) MRI Dicom files imported to ADAS VT. 4) Images segmented, slide based adjusted and manual model adjustment using specific tools of the software. 5) The tissue thresholds of the maximun and minimum pixel signal intensity of the myocardium in MRI were manually adjusted comparing MRI and scar reconstruction starting at default values of 30 % and 50 %.6. Channels were automatically detected using specific tool of the software.CONCLUSIONS: MRI has become a good method for the diagnosis, study and monitoring of cardiac pathologies, including Chagas disease This paper demonstrates that it is possible to characterize areas of myocardial fibrosis from MRI images and the subsequent analysis with an automatic arrhythmic substrate detection software allows the identification of slow conduction channels present in patients who most likely develop arrhythmic events.