Noya-Rabelo Marcia Maria, Macedo Carolina The, Larocca Ticiana, Machado Admilson, Pacheco Thais, Torreão Jorge, Souza Bruno Solano de Freitas, Soares Milena B P, Ribeiro-Dos-Santos Ricardo, Correia Luis Claudio Lemos
Hospital São Rafael - Fundação Monte Tabor, Salvador, BA - Brazil.
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil.
Arq Bras Cardiol. 2018 Feb;110(2):124-131. doi: 10.5935/abc.20180016. Epub 2018 Feb 19.
Previous data has shown that patients in the indeterminate form of Chagas disease may present myocardial fibrosis as shown on through magnetic resonance imaging (MRI). However, there is little information available regarding the degree of severity of myocardial fibrosis in these individuals. This variable has the potential to predict the evolution of Chagas' disease into its cardiac form.
To describe the frequency and extent of myocardial fibrosis evaluated using an MRI in patients in the indeterminate form, and to compare it with other forms of the disease.
Patients were admitted one after another. Their clinical history was collected and they were submitted to laboratory exams and an MRI.
Sixty-one patients with Chagas' disease, with an average age of 58 ± 9 years old, 17 patients in the indeterminate form, 16 in the cardiac form without left ventricular (LV) dysfunction and 28 in the cardiac form with LV dysfunction were studied. P <0.05 was considered to be statistically significant. Late enhancement was detected in 37 patients (64%). Myocardial fibrosis was identified in 6 individuals in indeterminate form (41%; 95% CI 23-66) in a proportion similar to that observed in cardiac form without LV dysfunction (44%); p = 1.0. Among the individuals with fibrosis, the total area of the affected myocardium was 4.1% (IIQ: 2.1 - 10.7) in the indeterminate form versus 2.3% (IIQ: 1-5) in the cardiac form without LV (p = 0.18). The left ventricular fraction ejection in subjects in the indeterminate form was similar to that of the individuals in the cardiac form without ventricular dysfunction (p = 0.09).
The presence of fibrosis in the indeterminate form of Chagas' disease has a frequency and extension similar to that of in the cardiac form without dysfunction, suggesting that the former is part of a subclinical disease spectrum, rather than lacking cardiac involvement.
既往数据显示，恰加斯病不确定型患者可能存在心肌纤维化，这可通过磁共振成像（MRI）显示。然而，关于这些个体中心肌纤维化的严重程度的信息很少。这一变量有可能预测恰加斯病向心脏型的演变。
描述使用MRI评估的不确定型患者心肌纤维化的频率和范围，并将其与该病的其他形式进行比较。
患者依次入院。收集他们的临床病史，并让他们接受实验室检查和MRI检查。
研究了61例恰加斯病患者，平均年龄为58±9岁，其中17例为不确定型，16例为无左心室（LV）功能障碍的心脏型，28例为有LV功能障碍的心脏型。P<0.05被认为具有统计学意义。在37例患者（64%）中检测到延迟强化。在6例不确定型个体中发现心肌纤维化（41%；95%CI 23-66），其比例与无LV功能障碍的心脏型中观察到的比例相似（44%）；p=1.0。在有纤维化的个体中，不确定型患者受影响心肌的总面积为4.1%（四分位数间距：2.1-10.7），而无LV功能障碍的心脏型患者为2.3%（四分位数间距：1-5）（p=0.18）。不确定型患者的左心室射血分数与无心室功能障碍的心脏型个体相似（p=0.09）。
恰加斯病不确定型中纤维化的存在频率和范围与无功能障碍的心脏型相似，这表明前者是亚临床疾病谱的一部分，而非缺乏心脏受累。
