Key result
Extensive LV and subendocardial scarring predicts ~93% higher risk of major events in Chagas cardiomyopathy.
Why the study?
Chagas cardiomyopathy is a major cause of cardiac morbidity and mortality in Latin America, but the role of CMR imaging in this setting remains under investigation.
Do CMR-derived parameters predict adverse clinical outcomes in patients with Chagas cardiomyopathy?
Cohort (n=133)
No
Do CMR-derived parameters predict adverse clinical outcomes in patients with Chagas cardiomyopathy?
Effect estimate: HR 1.93 (95% CI 1.06-3.52)
p-value: p=0.032
Subendocardial LV scarring and extensive myocardial fibrosis (≥6 segments with LGE) on CMR are independent predictors of adverse clinical outcomes in patients with Chagas cardiomyopathy.
May inform risk stratification via CMR in Chagas cardiomyopathy; observational data leave open need for prospective validation.
Background: Chagas cardiomyopathy (CC) is a major cause of cardiac morbidity and mortality in Latin America. The disease presents with varying degrees of myocardial involvement, posing a significant clinical challenge. Multimodal imaging plays a crucial role in patient assessment and management; however, the role of cardiac magnetic resonance (CMR) imaging in this context remains under investigation. Objective: To evaluate the association between CMR-derived parameters and the occurrence of adverse outcomes in patients with CC. Methods: Patients with CC underwent comprehensive CMR evaluation using a 1.5-T scanner. Imaging assessments included biventricular volumes, left ventricle ejection fraction (LVEF), right ventricle ejection fraction (RVEF) and late gadolinium enhancement (LGE) for scar analysis. Follow-up data were collected to assess a primary composite outcome comprising all-cause mortality, cardiovascular hospitalization, ischemic stroke, and heart transplantation. All-cause mortality was analyzed as a secondary outcome. Results: A total of 133 patients were included [median age 64 years, 71 (53.4%) female]. The mean LVEF was 43.3% ± 15%. LV scar was detected in 97% of patients. Myocardial edema, LV aneurysm, and LV thrombus were observed in 21.1%, 21.1%, and 12.8% of patients, respectively. The primary composite outcome occurred in 63 patients (47.4%). In multivariable analysis, age, subendocardial LV scarring, and extensive LV scar (≥6 segments with LGE) were independently associated with the primary outcome. Only age was independently associated with all-cause mortality. Conclusions: In patients with CC, subendocardial LV scarring and extensive myocardial fibrosis (≥6 segments with LGE) were independently associated with adverse clinical outcomes. These CMR-derived parameters may serve as valuable prognostic indicators in this high-risk population.
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Ariza-Ordóñez et al. (2026) conducted a cohort in Chagas cardiomyopathy (n=133). Extensive left ventricular scarring (≥ 6 segments with LGE) vs. < 6 segments with LGE was evaluated on Composite of all-cause mortality, cardiovascular hospitalization, ischemic stroke, and heart transplantation (HR 1.93, 95% CI 1.06-3.52, p=0.032). In patients with Chagas cardiomyopathy, extensive left ventricular scarring (≥6 segments) and subendocardial scarring independently predicted a composite of adverse clinical outcomes.
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