Lee-Felker S A, Thomas M, Felker E R, Traina M, Salih M, Hernandez S, Bradfield J, Lee M, Meymandi S
Department of Radiological Sciences, Ronald Reagan-UCLA Medical Center, United States.
Department of Radiological Sciences, Olive View-UCLA Medical Center- Center of Excellence for Chagas Disease, United States.
Clin Radiol. 2016 Jun;71(6):618.e1-7. doi: 10.1016/j.crad.2016.02.015. Epub 2016 Mar 24.
To determine whether cardiac magnetic resonance imaging (cMRI) is more sensitive than electrocardiogram (ECG) and echocardiogram (ECHO) for detecting myocardial involvement in a Latin American migrant population with untreated Chagas disease (CD) in the United States.
All untreated CD patients with ECG and ECHO examinations who underwent cMRI at Olive View-UCLA Medical Center from September 2010 to December 2013 (n=81) were analysed in three groups: Group 1, normal ECG and ECHO examinations (n=50); Group 2, abnormal ECG and normal ECHO examinations (n=10); and Group 3, abnormal ECHO examination (n=21). Frequencies of ECG, ECHO, and cMRI findings were compared across groups.
Seventy percent (57/81) of the study population was female, with a mean age of 47 years (range, 17-77 years). Twenty-six percent (21/81) had delayed myocardial enhancement (DME), which was most commonly inferolateral in location (27%, 32/117 segments) and transmural in pattern (56%, 65/117 segments). Eight percent (4/50), 30% (3/10), and 67% (14/21) of Groups 1-3, respectively, had DME. Of these individuals with DME, 50% (2/4), 67% (2/3), and 100% (14/14) of Groups 1-3, respectively, also had wall motion abnormality (WMA) on cMRI. In addition to the highest percentages of DME and WMA, Group 3 also had significantly higher mean myocardial mass (p<0.01), mean left ventricular end-diastolic (p<0.01) and end-systolic volumes (p<0.0005), and significantly lower mean left ventricular ejection fraction (p<0.001).
cMRI may detect myocardial involvement in untreated CD that is otherwise unrecognised on ECG and ECHO.
确定心脏磁共振成像（cMRI）在美国拉丁裔未治疗恰加斯病（CD）移民人群中检测心肌受累方面是否比心电图（ECG）和超声心动图（ECHO）更敏感。
对2010年9月至2013年12月在奥利夫维尤-加州大学洛杉矶分校医疗中心接受cMRI检查的所有未治疗的CD患者进行ECG和ECHO检查（n = 81），分为三组：第1组，ECG和ECHO检查正常（n = 50）；第2组，ECG异常而ECHO检查正常（n = 10）；第3组，ECHO检查异常（n = 21）。比较各组ECG、ECHO和cMRI检查结果的频率。
研究人群中70%（57/81）为女性，平均年龄47岁（范围17 - 77岁）。26%（21/81）有延迟心肌强化（DME），最常见于下外侧（27%，32/117节段），呈透壁型（56%，65/117节段）。第1 - 3组分别有8%（4/50）、30%（3/10）和67%（14/21）有DME。在这些有DME的个体中，第1 - 3组分别有50%（2/4）、67%（2/3）和100%（14/14）在cMRI上也有室壁运动异常（WMA）。除了DME和WMA的比例最高外，第3组的平均心肌质量也显著更高（p < 0.01），平均左心室舒张末期容积（p < 0.01）和收缩末期容积（p < 0.0005）显著更高，而平均左心室射血分数显著更低（p < 0.001）。
cMRI可能检测出未治疗CD患者中ECG和ECHO未发现的心肌受累情况。
