Miller D Douglas, Sharma Gyanendra K, Natla Sam, Javaheri Sean P, Arora Vishal
Medical College of Georgia, Augusta, Georgia, USA.
Medical College of Georgia, Augusta, Georgia, USA.
JACC Case Rep. 2025 Jun 25;30(16):104203. doi: 10.1016/j.jaccas.2025.104203.
Sudden cardiac death (SCD) in a nonimmunosuppressed individual from El Salvador who had visited 2 Trypanosoma cruzi seropositive siblings raised clinical suspicion for Chagas disease.
A 61-year-old male SCD survivor presented with electrocardiogram conduction abnormalities, cardiomegaly, myocardial necrosis with basal inferolateral aneurysm formation (echocardiography, left ventriculography), and sluggish contrast flow in the absence of coronary obstruction. Cardiac magnetic resonance defined the extent of myocardial fibrosis (delayed enhancement) from microvascular disease and guided endomyocardial biopsy. T. cruzi serology studies and circulating inflammatory markers supported late-stage Chagas cardiomyopathy.
Patients in T. cruzi-endemic regions are at an increased risk of developing Chagas cardiomyopathy, predisposing to SCD. Multimodal imaging provided indications for antiparasitic therapy to reduce disease progression and for dual-chamber implantable cardioverter defibrillator for secondary prevention in high-risk patients (Rassi score = 13).
TAKE-HOME MESSAGE: In SCD survivors with Chagas cardiomyopathy, multimodal cardiac imaging: 1) improves early management; 2) guides antiparasitic therapy; and 3) adds prognostic value.
一名来自萨尔瓦多的非免疫抑制个体突发心脏骤停，该个体曾拜访过2名克鲁斯锥虫血清学阳性的兄弟姐妹，这引发了对恰加斯病的临床怀疑。
一名61岁男性心脏骤停幸存者出现心电图传导异常、心脏扩大、心肌坏死伴基底后外侧动脉瘤形成（超声心动图、左心室造影），且在无冠状动脉阻塞的情况下造影剂流动缓慢。心脏磁共振成像确定了微血管疾病导致的心肌纤维化范围（延迟强化），并指导了心内膜活检。克鲁斯锥虫血清学研究和循环炎症标志物支持晚期恰加斯心肌病。
处于克鲁斯锥虫流行地区的患者患恰加斯心肌病的风险增加，易发生心脏骤停。多模态成像为抗寄生虫治疗以减少疾病进展以及为高危患者（拉西评分=13）进行二级预防的双腔植入式心脏复律除颤器提供了指征。
在患有恰加斯心肌病的心脏骤停幸存者中，多模态心脏成像：1）改善早期管理；2）指导抗寄生虫治疗；3）增加预后价值。
