Magnetic Resonance Imaging in Chronic Chagas' Disease: Correlation with Endomyocardial Biopsy Findings and Gallium-67 Cardiac Uptake.

BACKGROUND: We studied the correlation among cardiac magnetic resonance imaging (MRI), gallium-67 myocardial uptake, and right ventricular endomyocardial biopsy results in chronic Chagas' disease. To our knowledge, this represents the first attempt to correlate the histological findings with cardiac MRI and gallium-67 myocardial uptake for noninvasive diagnosis of inflammatory activity associated with Chagas' disease. METHODS: Ten male patients with cardiomyopathy secondary to Chagas' disease were studied (mean age, 47.7 +/- 7 years; congestive heart failure New York Heart Association [NYHA] functional class II [two patients], III [six patients], and IV [two patients]; and mean echocardiographic left ventricular [LV] ejection fraction [EF], 36 +/- 6%). The patients underwent right ventricular endomyocardial biopsy, cardiac MRI, and gallium-67 myocardial uptake testing. The results of this group were compared with those of a control group of patients with idiopathic dilated cardiomyopathy who were matched in age (mean age, 46 +/- 10 years), LV function (mean echocardiographic EF, 30 +/- 4%), and NYHA classification (one patient in class II, five patients in class III, and one patient in class IV). RESULTS: All patients with Chagas' disease showed higher signal intensity on MRI after the administration of gadolinium. The intensity of the septal signal changed from 0.90 +/- 0.11 to 1.56 +/- 0.19 (P < 0.001). In the control group, there was no difference in signal intensity with gadolinium (mean septal intensity, 0.94 +/- 0.12 before and 0.99 +/- 0.15 after; NS). On biopsy, eight chagasic patients had evident signs of myocarditis, and two patients had borderline evidence myocarditis. However, only one patient in the control group had a histological diagnosis of borderline myocarditis. Gallium-67 cardiac uptake was positive for myocardial inflammatory process in seven chagasic patients and borderline in one. On the other hand, only one patient in the control group had an uptake that was positive for inflammation, and one had a borderline result. CONCLUSIONS: In conclusion, the data from this study strongly suggest that myocarditis is frequently found in Chagas' disease. Cardiac MRI appears to be an accurate and alternative method for the diagnosis of inflammatory process associated with Chagas' disease.

Lipoprotein(a) and apolipoprotein profile of patients submitted to heart transplantation

Forty-three Caucasian heart transplantation (HT) patients were evaluated in a late evolutional phase (27 mais ou menos 20 months, median 24 months). They were on a stable immunosuppressive triple drug regime and were compared with 45 controls (NL). Lipoprotein(a) [Lp(a)], apolipoprotein (apo) AI, B (n=27) and total cholesterol (TC) and tryglicerides (TG) (n=43) were determined after a 14 hour fast. None of the patients had uremia or nephrotic syndrome, uncontrolled diabetes mellitus or other situation known to increased Lp(a) levels. They were not under hypolipidemic drugs. According to the results of serial coronary angiography, HT patients were further divided in two groups: GCD (n=9) and NGCD (n=19) respectively with or without graft coronary disease. Apo AI and Lp(a) were higher in HT patients than in NL, 1.7 mais ou menos 0,3 vs. 1.1 mais ou menos 0,4 g/l respectively, p<0,0001, and medians (25-75 percentiles) 26 (13.4-60.4) vs. 15 (2.4-33.4) mg/dl, p=0.026.TC, TG and apo B were similar in both groups. There were no differences on the lipid profile of both GCD and NGCD patients. These results suggest that Lp(a) is increased in HT, contrarily to early reports that this lipoprotein may be reduced in HT

Falso diagnóstico de miocardiopatia hipertrófica em feocromocitoma / A false dignosis of hypertrophic myocardiopathy in pheochromocytoma

A 24 year-old man was admitted with hypertensive crises and diagnosis hypothesis of neurofibromathosis and pheochromocytoma with blood pressure of 150 x 110mmHg and in use of anti-hypertensive drugs. The electrocardiogram (EKG) showed left ventricle hypertrophy. An echocardiogram showed interventricular septum (IVS) thickness of 16mm, posterior wall (PW) thickness of 11mm (ratio IVS/PW was 1.4). Diastolic ventricular diameter was 39mm with gradient of 52mmHg and mild mitral-valve murmur by pulsate Doppler. Increased vanillylmandelic acid and metanephrines in a 24-hour sample of urine has confirmed diagnosis of pheochromocytoma within was localized by 131I metaiodobenzyl-guanidine scan and computerized axial tomography. The patient was submitted to right adrenalectomy. Blood pressure was normalized. Evaluation an year later revealed a healthy man with normal laboratory exams, EKG and echocardiogram. It seems that the hypertrophy was consequence of the hypertension and pheochromocytoma, was not hypertrophic cardiomyopathy.

Homem de 24 anos foi admitido com hipótese diagnóstica de neurofibromatose e feocromocitoma, com pressão arterial (PA) de 150 x 110 mmHg e em uso de medicação anti-hipertensiva. O eletrocardiograma mostrava sobrecarga de ventrículo esquerda. O ecocardiograma relatado com diagnóstico de miocardiopatia hipertrófica assimétrica, mostrava a espessura de septo interventricular de 16mm, parede posterior de 11mm, diâmetro diastólico de 39mm, com gradiente intra-ventricular de 52mmHg e discreta regurgitação proto-sistólica valvar mitral ao doppler pulsátil. As dosagens de ácido vanilmandélico e de metanefrina urinárias confirmaram a suspeita clínica de feocromocitoma, localizado através da cintilografia com metaiodobenzilguanidina e tomografia axial computadorizada. Um ano após adrenalectomia direita se encontra assintomático, com PA, alterações laboratoriais, eletrocardiográficas e ecocardiográficas normais, evidenciando assim, que a hipertrofia de ventrículo esquerdo (HVE) era conseqüência da hipertensão arterial do feocromocitoma e não da miocardiopatia hipertrófica. Esta regressão da HVE excluiu, assim, o falso diagnóstico de micardiopatia hipertrófica

Lipoproteína (a), apoliproteínas e perfil lipídico em fase tardia após o transplante cardíaco / Lipoprotein (a), apolipoproteins and the lipid profile late after heart transplantation

Objetivo - Avaliar se a lipoproteína (a) [Lp(a)], apolipoproteína (apo) A1, apo B e perfil lipídico plasmático (PL) diferem os pacientes transplantados (TC) dos portadores de doença arterial coronariana (DAC) e os sem DAC (NL) e se o PL evidencia pacientes com doença coronariana do transplante (DCT). Métodos - Foram estudados 170 pacientes divididos em 3 grupos: I) TC [n= 43, 46 + ou - 15 anos, 24 meses (mediana) após o transplante], 28 submetidos a angiografia coronariana serial após o 1§ ano de cirurgia [subgrupos com DCT (n=9) e sem DCT (NDCT) (n=19)]; II) DAC (n=72, 48 + ou - 6 anos); III) NL (n=45, 50 + ou - 6 anos). Resultados - O grupo TC apresentou níveis maiores de apo A1 que DAC e NL [(1,5 + ou - 0,5 vs 1,2 + ou - 0,05 vs 1,1 + ou - 0,06 g/l, p<0,05). A apo B foi maior no DAC que TC e NL (1,5 + ou - 0,05 vs 1,2 + ou - 0,7 vs 1,3 + ou - 0,09 g/l p<0,05). A Lp(a) tendeu a ser maior em TC e DAC que NL [25 (2-97), 24(1-130) e 15 (1-100)mg/dl, p=0,05)]. Quando avaliados pareadamente vs os NL a Lp(a) foi maior nos TC e DAC (p=0,019 e 0,03). O PL näo diferiu entre DCT e NDCT. Conclusäo - Aumentos da Lp(a) após o transplante poderiam estar relacionados a elevada prevalência de DCT. O PL näo discriminou a DCT