Abstract 12675: A Modified Classification Scheme for Chaga's Cardiomyopathy Incorporating Cardiac Magnetic Resonance Imaging

Abstract

Introduction: The public health concerns from Chaga’s disease warrant improved cardiovascular imaging efforts. We present a novel and modified Chaga’s staging classification incorporating cardiac magnetic resonance imaging (CMR) to aid in diagnosing cardiomyopathies (CMs). (Figure 1) Case Presentation: An 18 year old asymptomatic military basic trainee screened serology positive for Trypanosoma Cruzi. A native of South Texas, he had frequent exposure to many triatome bugs without any history of chagoma or bites. Electrocardiogram showed sinus bradycardia, first degree atrioventricular delay, right bundle branch block with a left anterior fascicular block. Transthoracic echocardiogram (TTE) demonstrated a preserved left ventricular ejection fraction (LVEF), no wall motion abnormalities or valvular disease. Cardiopulmonary exercise testing demonstrated the trainee prematurely reaching anaerobic threshold. CMR was performed to evaluate specifically for delayed gadolinium enhancement and chamber size derangements for prognostication and military disposition purposes. CMR demonstrated mild left ventricular dilation, LVEF 65%, no late gadolinium enhancement, normal T1 relaxation time of 932 milliseconds, and normal T2 weighted images. The exposure history, positive serologies, electrocardiogram, and early ventricular remodeling were consistent with a Chaga’s dilated CM revealed with CMR improved spatial resolution. Case Outcome: Military standards currently prohibit cardiomyopathies from entering active duty service. The trainee was discharged and referred for medical therapy. Conclusions: We propose that CMR be incorporated into the Chaga’s classification schemes to (1) identify structural disease not apparent by TTE, (2) recognize fibrotic or inflammatory myocardial involvement which is prognosis altering, and (3) diagnose early involvement of CM which could benefit from earlier anti-parasitic therapy.