Accuracy of Trans-Thoracic Echocardiography Vs. Cardiac Magnetic Resonance for Assessing Ventricular Aneurysms in Patients with Chagasic Cardiomyopathy

INTRODUCTION: Chronic Chagas heart disease (CCHD) is characterized by left ventricular dilatation, dysfunction, scarring and presence of aneurysms. Apical ventricular aneurysms (AVA) may be underrecognized during conventional transthoracic echocardiogram (TTE), particularly when echo-contrast is not utilized, which is common in Latin-America due to its high cost. We aimed to determine the accuracy of TTE without contrast compared to cardiac magnetic resonance (CMR) for diagnosing ventricular aneurysms in these patients in a prospective cohort. METHODS: We included patients over 18 years of age who were positive for Chagas disease based on the Centers for Disease Control (CDC) diagnostic criteria. All patients had CMR and TTE the same day and we classified AVA as follows: Microaneurysms (limited to the segment AHA-17), macro-aneurysms (with extension to apical segments), and giant aneurysms (with extension to midventricular segments). Sensitivity, specificity, positive and negative predictive values of TTE were estimated for the total number of ventricular aneurysms and for each subgroup of AVA. RESULTS: A total of 79 patients were included of whom 51% were women with an average age of 59 ± 11 years old. Most patients where in NYHA functional class I-II and the most frequent comorbidities were diabetes mellitus and hypertension. The prevalence of any ventricular aneurysms by CMR was 24% and TTE had a sensitivity of 53% and a specificity of 97%. The positive and negative predictive values were 83% and 87%, respectively. In AVA, the sensitivity of the TTE was 0% for diagnosing microaneurysms, 60% for macro-aneurysms, and 100% for giant aneurysms. CONCLUSIONS: AVA by CMR were highly prevalent in our cohort of patients with CCHD. TTE sensitivity for AVA is limited and proportional to the size of the aneurysm. Of notice, the specificity and positive predictive values were high. Further efforts are needed to improve TTE accuracy of AVA particularly in countries endemic for the disease, such as use of echo-contrast, that may help prevent major events, particularly ischemic stroke.