Chagas’ cardiomyopathy

Chagas’ cardiomyopathy is a major complication emerging from Trypanosoma cruzi infection, appearing in up to 30% of individuals with positive serology and being the principal cause of death from heart failure in some areas of South America. The natural history of Chagas’ cardiomyopathy classically includes two phases: an acute phase, typically with absence of symptoms to mild, non-specific symptoms, and a chronic phase which comprises two forms of disease—an indeterminate (latent, pre-clinical) form and a determinate or clinical form. Patients with the indeterminate form may be asymptomatic for decades, until unidentified triggers initiate disease progression to chronic chagasic cardiomyopathy, manifesting in a broad range of clinical presentations, including cardiac arrhythmias, thromboembolism, heart failure, and sudden death. Non-invasive imaging modalities capable of characterizing not only cardiac morphology and function, but also myocardial tissue remodelling and disease progression, may play an important role in Chagas’ disease. Myocardial late gadolinium enhancement by cardiovascular magnetic resonance (CMR) has been considered the most accurate method to detect myocardial fibrosis in ischaemic and non-ischaemic cardiomyopathy, including Chagas’ cardiomyopathy. Myocardial tissue characterization, uniquely provided by CMR, holds enormous potential within a complex and not completely understood cardiomyopathy, with poor prognosis and limited therapeutic options. This chapter aims to discuss several relevant aspects of Chagas’ cardiomyopathy, focusing on the usefulness of CMR in the diagnosis and risk stratification of affected patients.