Abstract Several different imaging
methods can be used to evaluate
patients with Chagas
heart disease (CHD) for diagnostic and prognostic purposes, including plain
chest radiography;
echocardiography; myocardial
perfusion scintigraphy, for
detection of
ischemia and
fibrosis;
radionuclide gated-
angiography, for evaluation of biventricular function; 123I-
MIBG labeling of sympathetic myocardial
innervation; MRI, for
detection and quantitation of myocardial
fibrosis; and
coronary angiography. This study aims to
review the contributions of these
nuclear medicine methods to
understanding of the pathophysiology of chronic
Chagas cardiomyopathy (CCC). Careful
analysis and integration of findings provided by these imaging
methods in
patients with CCC at different stages has contributed significantly to improving
understanding of several peculiarities of the
disease. Clinical and experimental studies in
animal models show that
perfusion abnormalities detected in
association with dysfunctional but viable
myocardium are a common finding in CCC
patients and correspond to areas of cardiac
sympathetic denervation, as assessed by 123I-
MIBG imaging. Furthermore, recent
reports have demonstrated a close relationship between coronary microvascular disturbances and myocardial
inflammation. Thus, ongoing
research, mainly focused on refinements of 18F-FDF -
PET techniques and further exploration of nuclear
methods, such as
SPECT, have the potential to contribute to
detection and
monitoring of early subclinical myocardial damage thereby enabling evaluation of
therapeutic strategies targeting
inflammation and microvascular
ischemia that could result in better prognostic stratification of
patients with CHD.