Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease

Publication Date: January 1, 2018

Recommendations

Acute ChD

Echocardiography should be performed whenever acute ChD is suspected.
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A febrile illness accompanied by myocarditic findings on echocardiography and/or pericardial fluid should raise suspicion for acute ChD in endemic countries and in Latin American immigrants with immunosuppressed states living in nonendemic countries.
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As acute myocarditis is a common cardiac presentation, assessment of ejection fraction and wall motion abnormalities is of critical importance.
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Hypotension may be a sign of hemodynamically significant pericardial effusion leading to cardiac tamponade.
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Chronic ChD

Electrocardiography and echocardiography should be performed as part of the initial evaluation of all patients with newly diagnosed ChD, to exclude LV dysfunction and aneurysms as well as conduction abnormalities (right bundle branch, left anterior fascicular, and atrioventricular block) or arrhythmias.
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ECG follow-up is reasonable at least every 2 to 5 years in patients with ChD with the indeterminate form.
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Echocardiography should be performed if any changes in ECG findings or clinical condition suggesting possible HF are noted.
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The use of advanced imaging modalities to detect silent myocardial damage (such as strain imaging or CMR) in the indeterminate stage is currently not recommended, as it has limited clinical value.
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Recommendations for Imaging in Symptomatic Stages of ChHD

The overall goals of imaging are to identify the substrate for HF, thromboembolism, and malignant arrhythmias such as the presence of LV dysfunction, LV aneurysms or thrombus, myocardial fibrosis or inflammation, and regional sympathetic denervation.
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Although echocardiography is in general the preferred method, CMR is a valuable alternative and could achieve most of these goals. Nuclear angiography is valuable for evaluation of LV and RV function, while nuclear scintigraphy is helpful in detecting myocardial perfusion defects, fibrosis, or denervation.
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Monitoring of cardiac structure and function by echocardiography (and/or CMR) should be performed at least yearly in patients at stage B or higher, as it provides important prognostic information and could assist in making therapeutic decisions.
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In patients at stage B or higher, the imaging report should always include
  • LVEF
  • Regional wall motion abnormalities and aneurysms
  • LV diastolic function
  • RV function
  • Mitral and tricuspid regurgitation
  • Pulmonary artery systolic pressure
  • Presence of intracardiac thrombus and
  • Myocardial edema or fibrosis.
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Recommendation Grading

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Overview

Title

Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease

Authoring Organization

Publication Month/Year

January 1, 2018

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Provide recommendations for the use of cardiac ultrasound and other imaging modalities in the diagnosis, classification, and risk assessment of myocardial damage from early to advanced forms of ChHD.

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Outpatient

Intended Users

Radiology technologist, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis

Diseases/Conditions (MeSH)

D014355 - Chagas Disease, D002598 - Chagas Cardiomyopathy

Keywords

cardiomyopathy, Chagas, Left ventricular aneurysm

Source Citation

Acquatella, H., Asch, F. M., Barbosa, M. M., Barros, M., Bern, C., Cavalcante, J. L., … Viotti, R. (2018). Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC). Journal of the American Society of Echocardiography, 31(1), 3–25. doi:10.1016/j.echo.2017.10.019

Supplemental Methodology Resources

Data Supplement