title: Chagas' heart disease: gender differences in myocardial damage assessed by cardiovascular magnetic resonance.
abstract: BACKGROUND
  Since a male-related higher cardiovascular morbidity and mortality in patients with Chagas' heart disease has been reported, we aimed to investigate gender differences in myocardial damage assessed by cardiovascular magnetic resonance (CMR).
  
  
  RESULTS
  Retrospectively, 62 seropositive Chagas' heart disease patients referred to CMR (1.5 T) and with low probability of having significant coronary artery disease were included in this analysis. Amongst both sexes, there was a strong negative correlation between LV ejection fraction and myocardial fibrosis (male r = 0.64, female r = 0.73, both P < 0.001), with males showing significantly greater myocardial fibrosis (P = 0.002) and lower LV ejection fraction (P < 0.001) than females. After adjustment for potential confounders, gender remained associated with myocardial dysfunction, and 53% of the effect was mediated by myocardial fibrosis (P for mediation = 0.004). Also, the transmural pattern was more prevalent among male patients (23.7 vs. 9.9%, P < 0.001) as well as the myocardial heterogeneity or gray zone (2.2 vs. 1.3 g, P = 0.003).
  
  
  CONCLUSIONS
  We observed gender-related differences in myocardial damage assessed by CMR in patients with Chagas' heart disease. As myocardial fibrosis and myocardial dysfunction are associated to cardiovascular outcomes, our findings might help to understand the poorer prognosis observed in males in Chagas' disease.
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Antonildes N
authors.initials: AN
authors.lastname: Assunção
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Rodrigo L
authors.initials: RL
authors.lastname: Melo
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Alejandra V
authors.initials: AV
authors.lastname: Mauricio
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Liliane
authors.initials: L
authors.lastname: Rocha
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Torreão
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Fabio
authors.initials: F
authors.lastname: Fernandes
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Ianni
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil-Filho
authors.affiliation: Heart Institute, InCor, University of Sao Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. rochitte@incor.usp.br.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
mesh_terms: D000328:Adult; D000368:Aged; D002598:Chagas Cardiomyopathy / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D005355:Fibrosis; D054624:Health Status Disparities; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Chagas’ heart disease; Gender differences; Myocardial dysfunction; Myocardial fibrosis