Radionuclide Imaging in Chagas Cardiomyopathy

Purpose of Review

To review the contributions of radionuclide imaging to understanding the manifestations and pathophysiology of chronic Chagas cardiomyopathy (CCC).

Recent Findings

Experimental studies using high-resolution SPECT myocardial perfusion imaging (MPI) show that myocardial perfusion derangement that corresponds to dysfunctional, viable myocardium is closely linked to inflammation and precedes LV regional systolic dysfunction. Clinical studies show that microvascular ischemia is strictly related to the areas of cardiac sympathetic denervation, assessed by ¹²³I-MIBG imaging, which correlates with severe ventricular arrhythmia incidence. Initial case reports suggest that ¹⁸F-FDG-PET imaging is a promising, non-invasive detection method for myocardial inflammation.

Summary

Available evidence indicates that microvascular ischemia participates in the mechanisms causing myocardial injury in CCC, with potential implication for monitoring subclinical disease progression. Moreover, MIBG imaging is a promising tool for risk stratification of sudden death. Preliminary clinical experience suggests a role for ¹⁸F-FDG-PET in detection of inflammation in CCC.