Cardiac magnetic resonance predictors of adverse outcomes in Chagas cardiomyopathy.

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.