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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Chadalawada S, Rassi A, Samara O, Monzon A, Gudapati D, Vargas Barahona L, Hyson P, Sillau S, Mestroni L, Taylor M, da Consolação Vieira Moreira M, DeSanto K, Agudelo Higuita NI, Franco-Paredes C, Henao-Martínez AF. Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta-analysis. ESC Heart Fail 2021; 8:5466-5481. [PMID: 34716744 PMCID: PMC8712892 DOI: 10.1002/ehf2.13648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 11/09/2022] Open
Abstract
Aims This study aimed to estimate the annual mortality risk and its determinants in chronic Chagas cardiomyopathy. Methods and results We conducted a systematic search in MEDLINE, Web of Science Core Collection, Embase, Cochrane Library, and LILACS. Longitudinal studies published between 1 January 1946 and 24 October 2018 were included. A random‐effects meta‐analysis using the death rate over the mean follow‐up period in years was used to obtain pooled estimated annual mortality rates. Main outcomes were defined as all‐cause mortality, including cardiovascular, non‐cardiovascular, heart failure, stroke, and sudden cardiac deaths. A total of 5005 studies were screened for eligibility. A total of 52 longitudinal studies for chronic Chagas cardiomyopathy including 9569 patients and 2250 deaths were selected. The meta‐analysis revealed an annual all‐cause mortality rate of 7.9% [95% confidence interval (CI): 6.3–10.1; I2 = 97.74%; T2 = 0.70] among patients with chronic Chagas cardiomyopathy. The pooled estimated annual cardiovascular death rate was 6.3% (95% CI: 4.9–8.0; I2 = 96.32%; T2 = 0.52). The annual mortality rates for heart failure, sudden death, and stroke were 3.5%, 2.6%, and 0.4%, respectively. Meta‐regression showed that low left ventricular ejection fraction (coefficient = −0.04; 95% CI: −0.07, −0.02; P = 0.001) was associated with an increased mortality risk. Subgroup analysis based on American Heart Association (AHA) classification revealed pooled estimate rates of 4.8%, 8.7%, 13.9%, and 22.4% (P < 0.001) for B1/B2, B2/C, C, and C/D stages of cardiomyopathy, respectively. Conclusions The annual mortality risk in chronic Chagas cardiomyopathy is substantial and primarily attributable to cardiovascular causes. This risk significantly increases in patients with low left ventricular ejection fraction and those classified as AHA stages C and C/D.
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Affiliation(s)
- Sindhu Chadalawada
- Department of Medicine, Alameda Health System-Highland Hospital, Oakland, CA, USA
| | - Anis Rassi
- Division of Cardiology, Anis Rassi Hospital, Goiânia, GO, Brazil
| | - Omar Samara
- School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Anthony Monzon
- School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | | | | | - Peter Hyson
- Hospital Infantil de México, Federico Gómez, México City, Mexico
| | - Stefan Sillau
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Luisa Mestroni
- Adult Medical Genetics Program, Cardiovascular Institute, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Matthew Taylor
- Adult Medical Genetics Program, Cardiovascular Institute, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Maria da Consolação Vieira Moreira
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kristen DeSanto
- Health Sciences Library, University of Colorado Denver, Aurora, CO, USA
| | | | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, México City, Mexico.,Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Andrés F Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
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3
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Gonçalves R, Landivar D, Grover Sañez Liendo E, Mamani Fernandez J, Ismail HM, Paine MJI, Courtenay O, Bern C. Improving houses in the Bolivian Chaco increases effectiveness of residual insecticide spraying against infestation with Triatoma infestans, vector of Chagas disease. Trop Med Int Health 2021; 26:1127-1138. [PMID: 34114721 DOI: 10.1111/tmi.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Failure to control domestic Triatoma infestans in the Chaco is attributed to vulnerable adobe construction, which provides vector refuges and diminishes insecticide contact. We conducted a pilot to test the impact of housing improvement plus indoor residual spraying (IRS) on house infestation and vector abundance in a rural community in the Bolivian Chaco. METHODS The intervention included three arms: housing improvement + IRS [HI], assisted IRS [AS] in which the team helped to clear the house pre-IRS and routine IRS [RS]. HI used locally available materials, traditional construction techniques and community participation. Vector parameters were assessed by Timed Manual Capture for 2 person-hours per house at baseline and medians of 114, 173, 314, 389 and 445 days post-IRS-1. A second IRS round was applied at a median of 314 days post-IRS-1. RESULTS Post-intervention infestation indices and abundance fell in all three arms. The mean odds of infestation was 0.29 (95% CL 0.124, 0.684) in the HI relative to the RS arm. No difference was observed between AS and RS. Vector abundance was reduced by a mean 44% (24.8, 58.0) in HI compared to RS, with no difference between AS and RS. Median delivered insecticide concentrations per house were lower than the target of 50 mg/m2 in >90% of houses in all arms. CONCLUSION Housing improvement using local materials and community participation is a promising strategy to improve IRS effectiveness in the Bolivian Chaco. A larger trial is needed to quantify the impact on reinfestation over time.
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Affiliation(s)
- Raquel Gonçalves
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, UK
| | | | | | | | - Hanafy M Ismail
- Liverpool School of Tropical Medicine, Department of Vector Biology, Liverpool, UK
| | - Mark J I Paine
- Liverpool School of Tropical Medicine, Department of Vector Biology, Liverpool, UK
| | - Orin Courtenay
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, UK
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Buss LF, Bes TM, Pereira A, Natany L, Oliveira CDL, Ribeiro ALP, Sabino EC. Deriving a parsimonious cardiac endpoint for use in epidemiological studies of Chagas disease: results from the Retrovirus Epidemiology Donor Study-II (REDS-II) cohort. Rev Inst Med Trop Sao Paulo 2021; 63:e31. [PMID: 33909845 PMCID: PMC8075618 DOI: 10.1590/s1678-9946202163031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Abstract
Chagas cardiomyopathy (ChCM) is a severe consequence of Trypanosoma cruzi infection and has a range of electrocardiographic (ECG) and echocardiographic (ECHO) manifestations. There is a need for a standard and parsimonious research cardiac end point that does not rely on expert panel adjudication, and it is not intended to change the ChCM definition. We use data from the REDS-II cohort to propose a simplified cardiac endpoint. A total of 499 T. cruzi-seropositive blood donors were included. All participants underwent a 12-lead ECG, echocardiogram and clinical examination, and those with abnormal findings were reviewed by a panel of cardiologists who classified cases as having Chagas cardiomyopathy or not. We created an exhaustive set of ECG and ECHO finding combinations and compared these with the panel's classification. We selected the simplest combination that most accurately reproduced the panel's results. Individual ECG and ECHO variables had low sensitivity for panel-defined cardiomyopathy. The best performing combination was right bundle branch block and/or ECHO evidence of left ventricular hypocontractility. This combination had 98% specificity and 85% sensitivity for panel-defined ChCM. It was not possible to improve the overall accuracy by addition of any other ECG or ECHO variable. Substituting right bundle branch block for the more inclusive finding of QRS interval > 120 ms produced similar results. The combination of prolonged QRS interval and/or left ventricular hypocontractility closely reproduced the REDS-II expert panel classification of Chagas ChCM. In conclusion, the simple and reproducible research endpoint proposed here captures most of the spectrum of cardiac abnormalities in Chagas disease.
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Affiliation(s)
- Lewis F Buss
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Taniela Marli Bes
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Alexandre Pereira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto do Coração, Laboratório de Genética e Cardiologia Molecular, São Paulo, São Paulo, Brazil
| | - Larissa Natany
- Universidade Federal de Minas Gerais, Departamento de Estatística, Belo Horizonte, Minas Gerais, Brazil
| | | | - Antonio Luiz P Ribeiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
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Abstract
Since the initial descriptions of Chagas cardiomyopathy (ChCM), the electrocardiography has played a key role in patient evaluations. The diagnostic criterion of chronic ChCM is the presence of characteristic electrocardiographic (ECG) abnormalities in seropositive individuals, regardless of the presence of symptoms. However, these ECG abnormalities are rarely specific to ChCM and, particularly among the elderly, can be caused by other simultaneous cardiomyopathies. ECG abnormalities can predict the occurrence of heart failure, stroke, and even death. Nevertheless, most prognostic studies have included Chagas disease (ChD) populations and, not exclusively, ChCM. Thus, more studies are required to evaluate the efficacy of ECG in predicting reliable prognoses in established chronic ChCM. This review exclusively discusses the role of the 12-lead ECG in the clinical evaluation of chronic ChD.
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Affiliation(s)
- Bruno Oliveira de Figueiredo Brito
- Programa de Pós-Graduação Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Antônio Luiz Pinho Ribeiro
- Programa de Pós-Graduação Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Nunes MCP, Beaton A, Acquatella H, Bern C, Bolger AF, Echeverría LE, Dutra WO, Gascon J, Morillo CA, Oliveira-Filho J, Ribeiro ALP, Marin-Neto JA. Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e169-e209. [DOI: 10.1161/cir.0000000000000599] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Chagas disease, resulting from the protozoan
Trypanosoma cruzi
, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission.
Methods and Results:
The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of
T cruzi
infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease.
Conclusions:
This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world.
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Moraes DN, Nascimento BR, Beaton AZ, Soliman EZ, Lima-Costa MF, dos Reis RC, Ribeiro ALP. Value of the Electrocardiographic (P Wave, T Wave, QRS) Axis as a Predictor of Mortality in 14 Years in a Population With a High Prevalence of Chagas Disease from the Bambuí Cohort Study of Aging. Am J Cardiol 2018; 121:364-369. [PMID: 29191568 DOI: 10.1016/j.amjcard.2017.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
We sought to investigate the prognostic value of the electrocardiogram (ECG) electrical axes (P wave, T wave and QRS) as predictors of mortality in the 14-year follow-up of the prospective cohort of all residents ≥60 years living in the southeastern Brazilian city of Bambuí, a population with high prevalence of Chagas disease (ChD). Baseline ECG axes were automatically measured with normal values defined as follows: P-wave axis 0° to 75°, QRS axis -30° to 90°, and T axis 15° to 75°. Participants underwent annual follow-up visits and death was verified using death certificates. Cox proportional hazards regression was used to assess the prognostic value of ECG axes for all-cause mortality, after adjustment for potential confounders. From 1,742 qualifying residents, 1,462 were enrolled, of whom 557 (38.1%) had ChD. Mortality rate was 51.9%. In multivariable adjusted models, abnormal P-wave axis was associated with a 48% (hazard ratio [HR] = 1.48 [95% confidence interval (CI) 1.16-1.88]) increased mortality risk in patients with ChD and 43% (HR = 1.43 [CI 1.13-1.81]) in patients without ChD. Abnormal QRS axis was associated with a 34% (HR = 1.34 [CI 1.04-1.73]) increased mortality risk in patients with ChD, but not in individuals without ChD. Similarly, in the ChD group, abnormal T-wave axis was associated with a 35% (HR = 1.35 [CI 1.07-1.71]) increased mortality, but not in patients without ChD. In conclusion, abnormal P-wave, QRS, and T-wave axes were associated with increased all-cause mortality in patients with ChD. Abnormal P-wave axis was associated with mortality also among those without ChD, being the strongest predictor among ECG variables.
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Capuani L, Bierrenbach AL, Pereira Alencar A, Mendrone A, Ferreira JE, Custer B, P. Ribeiro AL, Cerdeira Sabino E. Mortality among blood donors seropositive and seronegative for Chagas disease (1996-2000) in São Paulo, Brazil: A death certificate linkage study. PLoS Negl Trop Dis 2017; 11:e0005542. [PMID: 28545053 PMCID: PMC5436632 DOI: 10.1371/journal.pntd.0005542] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/31/2017] [Indexed: 12/03/2022] Open
Abstract
Background Individuals in the indeterminate phase of Chagas disease are considered to have mortality rates similar to those of the overall population. This study compares mortality rates among blood donors seropositive for Chagas disease and negative controls in the city of São Paulo, Brazil. Methodology/principal findings This is a retrospective cohort study of blood donors from 1996 to 2000: 2842 seropositive and 5684 seronegative for Chagas disease. Death status was ascertained by performing probabilistic record linkage (RL) with the Brazil national mortality information system (SIM). RL was assessed in a previous validation study. Cox Regression was used to derive hazard ratios (HR), adjusting for confounders. RL identified 159 deaths among the 2842 seropositive blood donors (5.6%) and 103 deaths among the 5684 seronegative (1.8%). Out of the 159 deaths among seropositive donors, 26 had the 10th International Statistical Classification of Diseases and Related Health Problems (ICD-10) indicating Chagas disease as the underlying cause of death (B57.0/B57.5), 23 had ICD-10 codes (I42.0/I42.2/I47.0/I47.2/I49.0/I50.0/I50.1/ I50.9/I51.7) indicating cardiac abnormalities possibly related to Chagas disease listed as an underlying or associated cause of death, with the others having no mention of Chagas disease in part I of the death certificate. Donors seropositive for Chagas disease had a 2.3 times higher risk of death due to all causes (95% Confidence Interval (95% CI), 1.8–3.0) than seronegative donors. When considering deaths due to Chagas disease or those that had underlying causes of cardiac abnormalities related to Chagas disease, seropositive donors had a risk of death 17.9 (95% CI, 6.3–50.8) times greater than seronegative donors. Conclusions/significance There is an excess risk of death in donors seropositive blood for Chagas disease compared to seronegative donors. Chagas disease is an under-reported cause of death in the Brazilian mortality database. Chagas disease is classified as one of the 17 most important neglected diseases by the World Health Organization (WHO). The majority of infected individuals live in 21 countries of Central and South America. Estimates of mortality attributable to Chagas disease vary considerably (between 0.2% and 19.2% annually). To improve the measurement of disease burden and policy decision-making in regard to treatment availability, more accurate estimates of mortality, especially among otherwise asymptomatic seropositive individuals are needed,. This study compares mortality rates and causes of death of asymptomatic blood donors who tested seropositive for Chagas disease and seronegative for all screening tests conducted in Brazil. Mortality status was ascertained by linking donor names with the Brazilian national mortality information system (SIM). The study found that donors who tested Chagas disease seropositive had risk of death from all causes 2.3 (95% CI, 1.8–3.0) times greater than seronegative ones. The data also suggest that the SIM may underestimate the total number of deaths attributable to Chagas disease in Brazil.
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Affiliation(s)
- Ligia Capuani
- Department of Infectious Diseases, School of Medicine—University of Sao Paulo—FMUSP, Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Ana Luiza Bierrenbach
- Institute of Education and Research, Hospital Sirio Libanes, Sao Paulo, Sao Paulo, Brazil
| | - Airlane Pereira Alencar
- Department of Statistics, Institute of Mathematics and Statistics, University of Sao Paulo—IME-USP, Sao Paulo, Sao Paulo, Brazil
| | - Alfredo Mendrone
- Fundação Pró-Sangue—Hemocenter of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - João Eduardo Ferreira
- Department of Computer Science, Institute of Mathematics and Statistics, University of Sao Paulo—IME-USP, Sao Paulo, Sao Paulo, Brazil
| | - Brian Custer
- Epidemiology and Health Policy Research, Blood Systems Research Institute—BSRI, San Francisco, California, United States of America
| | - Antonio Luiz P. Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais—UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Department of Infectious Diseases, School of Medicine and Tropical Medicine Institute—University of Sao Paulo—FMUSP, Sao Paulo, Sao Paulo, Brazil
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Yager JE, Lozano Beltran DF, Torrico F, Gilman RH, Bern C. Prevalence of Chagas heart disease in a region endemic for Trypanosoma cruzi: evidence from a central Bolivian community. Glob Heart 2015; 10:145-50. [PMID: 26407509 DOI: 10.1016/j.gheart.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/22/2015] [Accepted: 07/09/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Though the incidence of new Trypanosoma cruzi infections has decreased significantly in endemic regions in the Americas, medical professionals continue to encounter a high burden of resulting Chagas disease among infected adults. The current prevalence of Chagas heart disease in a community setting is not known; nor is it known how recent insecticide vector control measures may have impacted the progression of cardiac disease in an infected population. OBJECTIVES We sought to determine the current prevalence of T. cruzi infection and associated Chagas heart disease in a Bolivian community endemic for T. cruzi. METHODS Nested within a community serosurvey in rural and periurban communities in central Bolivia, we performed a cross-sectional cardiac substudy to evaluate adults for historical, clinical, and electrocardiographic evidence of cardiac disease. All adults between the ages of 20 and 60 years old with T. cruzi infection and those with a clinical history, physical exam, or electrocardiogram consistent with cardiac abnormalities were also scheduled for echocardiography. RESULTS Of the 604 cardiac substudy participants with definitive serology results, 183 were seropositive for infection with T. cruzi (30.3%). Participants who were seropositive for T. cruzi infection were more likely to have conduction system defects (1.6% vs. 0% for complete right bundle branch block and 10.4% vs. 1.9% for any bundle branch block; p = 0.008 and p < 0.001, respectively). However, there was no statistically significant difference in the prevalence of bradycardia among seropositive versus seronegative participants. Echocardiogram findings were not consistent with a high burden of Chagas cardiomyopathy: valvulopathies were the most common abnormality, and few participants were found to have low ejection fraction or left ventricular dilatation. No participants had significant heart failure. CONCLUSIONS Though almost one-third of adults in the community were seropositive for T. cruzi infection, few had evidence of Chagas heart disease.
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Fernandez AB, Nunes MCP, Clark EH, Samuels A, Menacho S, Gomez J, Bozo Gutierrez RW, Crawford TC, Gilman RH, Bern C. Electrocardiographic and echocardiographic abnormalities in Chagas disease: findings in residents of rural Bolivian communities hyperendemic for Chagas disease. Glob Heart 2016; 10:159-66. [PMID: 26407511 DOI: 10.1016/j.gheart.2015.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/15/2015] [Accepted: 07/09/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Chagas disease is a neglected and preventable tropical disease that causes significant cardiac morbidity and mortality in Latin America. OBJECTIVES This study sought to describe cardiac findings among inhabitants of rural communities of the Bolivian Chaco. METHODS The cardiac study drew participants from an epidemiologic study in 7 indigenous Guarani communities. All infected participants 10 years or older were asked to undergo a brief physical examination and 12-lead electrocardiogram (ECG). A subset had echocardiograms. ECG and echocardiograms were read by 1 or more cardiologists. RESULTS Of 1,137 residents 10 years or older, 753 (66.2%) had Trypanosoma cruzi infection. Cardiac evaluations were performed for 398 infected participants 10 years or older. Fifty-five participants (13.8%) had 1 or more ECG abnormalities suggestive of Chagas cardiomyopathy. The most frequent abnormalities were bundle branch blocks in 42 (11.3%), followed by rhythm disturbances or ventricular ectopy in 13 (3.3%), and atrioventricular blocks (AVB) in 10 participants (2.6%). The prevalence of any abnormality rose from 1.1% among those 10 to 19 years old to 14.2%, 17.3%, and 26.4% among those 20 to 39, 40 to 59, and older than 60 years, respectively. First-degree AVB was seen most frequently in participants 60 years or older, but the 4 patients with third-degree AVB were all under 50 years old. Eighteen and 2 participants had a left ventricular ejection fraction of 40% to 54% and <40%, respectively. An increasing number of ECG abnormalities was associated with progressively larger left ventricular end-diastolic dimensions and lower left ventricular ejection fraction. CONCLUSIONS We found a high prevalence of ECG abnormalities and substantial evidence of Chagas cardiomyopathy. Programs to improve access to basic cardiac care (annual ECG, antiarrhythmics, pacemakers) could have an immediate impact on morbidity and mortality in these highly endemic communities.
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Affiliation(s)
- Antonio B Fernandez
- Division of Cardiology, Hartford Hospital and University of Connecticut School of Medicine, Hartford, CT, USA.
| | - Maria Carmo P Nunes
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Eva H Clark
- Baylor College of Medicine, Houston, TX, USA
| | - Aaron Samuels
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jesus Gomez
- Hospital San Juan de Dios, Santa Cruz, Bolivia
| | | | - Thomas C Crawford
- Department of Cardiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Andrade CDM, Câmara ACJD, Nunes DF, Guedes PMDM, Pereira WO, Chiari E, Diniz RVZ, Galvão LMDC. Chagas disease: morbidity profile in an endemic area of Northeastern Brazil. Rev Soc Bras Med Trop 2016; 48:706-15. [PMID: 26676495 DOI: 10.1590/0037-8682-0235-2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/05/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil). METHODS This cross-sectional study included 186 adults who were evaluated using electrocardiography, echocardiography, chest radiography, and contrast radiography of the esophagus and colon. A clinical-epidemiological questionnaire was also used. RESULTS The indeterminate, cardiac, digestive, and cardiodigestive clinical forms of Chagas disease were diagnosed in 51.6% (96/186), 32.2% (60/186), 8.1% (15/186) and 8.1% (15/186) of the participants, respectively. Heart failure (functional classes I-IV) was detected in 7.5% (14/186) of the participants, and 36.4% (24/66), 30.3% (20/66), 15.2% (10/66), 13.6% (9/66), and 4.5% (3/66) of the patients were at stage A, B1, B2, C, and D, respectively. Dilated cardiomyopathy and electrocardiographic changes were detected in 10.2% (19/186) and 48.1% (91/186) of the participants, respectively. Apical aneurysm was diagnosed in 10.8% (20/186) of the participants, and other changes in the segmental myocardial contractility of the left ventricle were diagnosed in 33.9% (63/186) of the participants. Megaesophagus (groups I-IV) was observed in 7% (13/186) of the participants, megacolon (grades 1-3) was detected in 12.9% (24/186) of the participants, and both organs were affected in 29.2% (7/24) of the megacolon cases. CONCLUSIONS We detected various clinical forms of Chagas disease (including the digestive form). Our findings indicate that clinical symptoms alone may not be sufficient to exclude or confirm cardiac and/or digestive damage, and the number of patients with symptomatic clinical forms may be underestimated.
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Affiliation(s)
- Cléber de Mesquita Andrade
- Programa de Pós-Graduação em Ciências da Saúde, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Antônia Cláudia Jácome da Câmara
- Departamento de Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Daniela Ferreira Nunes
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Marcos da Matta Guedes
- Departamento de Microbiologia e Parasitologia, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Wogelsanger Oliveira Pereira
- Faculdade de Ciências da Saúde, Universidade do Estado do Rio Grande do Norte, Mossoró, Rio Grande do Norte, Brazil
| | - Egler Chiari
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosiane Viana Zuza Diniz
- Programa de Pós-Graduação em Ciências da Saúde, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lúcia Maria da Cunha Galvão
- Programa de Pós-Graduação em Ciências da Saúde, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Quinde-Calderón L, Rios-Quituizaca P, Solorzano L, Dumonteil E. Ten years (2004-2014) of Chagas disease surveillance and vector control in Ecuador: successes and challenges. Trop Med Int Health 2015; 21:84-92. [PMID: 26458237 DOI: 10.1111/tmi.12620] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe the current situation of Chagas disease in Ecuador and to evaluate the impact of vector control for the period 2004-2014. METHODS Since 2004, the Ministry of Public Health has formalized activities for the surveillance and control of Chagas disease and we analyzed here available records. RESULTS More than 200 000 houses were surveyed, and 2.6% were found to be infested (95% CI: 2.6-2.7), and more than 51 000 houses were sprayed with residual insecticide, with important yearly variations. A total of 915 cases of T. cruzi infection were registered. The Amazon region is emerging as a high priority area, where nearly half of T. cruzi infection cases originate. The costal region and the southern highland valleys remain important high-risk area. Vector control efforts over the past 10 years have been effective in the coastal region, where T. dimidiata predominates, and resulted in important reductions in house infestation indices in many areas, even reaching negligible levels in some parishes. CONCLUSION Vector efforts need to be sustained and expanded for the elimination of T. dimidiata to be feasible. Novel vector control interventions need to be designed to reduce intrusion by several triatomine species present in the Amazon region and southern Ecuador. Strong political commitment is needed to sustain current achievements and improve the national coverage of these programmes.
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Affiliation(s)
- Leonardo Quinde-Calderón
- Programa Nacional de Chagas, Leishmaniasis y Oncocercosis, Ministerio de Salud Pública, Guayaquil, Ecuador
| | | | - Luis Solorzano
- Subproceso de Parasitologia, Instituto Nacional de Investigación en Salud Pública, Guayaquil, Ecuador
| | - Eric Dumonteil
- Subproceso de Parasitologia, Instituto Nacional de Investigación en Salud Pública, Guayaquil, Ecuador.,Laboratorio de Parasitología, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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CARDOSO RHANDERSON, GARCIA DANIEL, FERNANDES GILSON, HE LI, LICHTENBERGER PAOLA, VILES-GONZALEZ JUAN, COFFEY JAMESO, MITRANI RAULD. The Prevalence of Atrial Fibrillation and Conduction Abnormalities in Chagas’ Disease: A Meta-Analysis. J Cardiovasc Electrophysiol 2015; 27:161-9. [DOI: 10.1111/jce.12845] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 12/15/2022]
Affiliation(s)
- RHANDERSON CARDOSO
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - DANIEL GARCIA
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - GILSON FERNANDES
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - LI HE
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - PAOLA LICHTENBERGER
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - JUAN VILES-GONZALEZ
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - JAMES O. COFFEY
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - RAUL D. MITRANI
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
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14
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Kaplinski M, Jois M, Galdos-Cardenas G, Rendell VR, Shah V, Do RQ, Marcus R, Pena MSB, Abastoflor MDC, LaFuente C, Bozo R, Valencia E, Verastegui M, Colanzi R, Gilman RH, Bern C. Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia. Clin Infect Dis 2015; 61:918-26. [PMID: 26063720 DOI: 10.1093/cid/civ446] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/02/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women. METHODS Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG). RESULTS Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house. CONCLUSIONS We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.
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Affiliation(s)
- Michelle Kaplinski
- Department of Cardiology, Children's Hospital of Philadelphia, Pennsylvania
| | - Malasa Jois
- Division of Internal Medicine, Brown University, Providence, Rhode Island
| | - Gerson Galdos-Cardenas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Universidad Católica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | | | - Vishal Shah
- Saint Louis University School of Medicine, Missouri
| | - Rose Q Do
- Department of Cardiology, University of Colorado, Denver
| | - Rachel Marcus
- Department of Cardiology, Washington Hospital Center, Washington, District of Columbia
| | | | | | | | - Ricardo Bozo
- Camiri Municipal Hospital, Camiri, Plurinational State of Bolivia
| | - Edward Valencia
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuela Verastegui
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rony Colanzi
- Universidad Católica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine
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Mundaray Fernández N, Fernández-Mestre M. The role of haptoglobin genotypes in Chagas disease. Dis Markers 2014; 2014:793646. [PMID: 25147423 DOI: 10.1155/2014/793646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/11/2014] [Indexed: 11/17/2022]
Abstract
Although the number of people infected with T. cruzi is on the rise, host genetic and immune components that are crucial in the development of the Chagas disease have been discovered. We investigated the frequency of polymorphisms in the gene encoding haptoglobin of patients with chronic Chagas disease. The results suggest that while the HP1-1 genotype may confer protection against infection and the development of chronic Chagas disease due to the rapid metabolism of the Hp1-1-Hb complex and its anti-inflammatory activity, the presence of HP2-2 genotype may increase susceptibility towards a chronic condition of the disease due to a slow metabolism of the Hp2-2-Hb complex, lower antioxidant activity, and increased inflammatory reactivity, which lead to cell damage and a deterioration of the cardiac function. Finally, correlations between HP genotypes in different age groups and cardiac manifestations suggest that HP polymorphism could influence the prognosis of this infectious disease. This study shows some of the relevant aspects of the haptoglobin gene polymorphism and its implications in the T. cruzi infection.
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16
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Santos AM, Scanavacca MI, Darrieux F, Ianni B, de Melo SL, Pisani C, Santos Neto F, Sosa E, Hachul DT. Baroreflex sensitivity and its association with arrhythmic events in Chagas disease. Arq Bras Cardiol 2014; 102:579-87. [PMID: 25004420 PMCID: PMC4079022 DOI: 10.5935/abc.20140066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/24/2014] [Indexed: 11/21/2022] Open
Abstract
Background Sudden death is the leading cause of death in Chagas disease (CD), even in
patients with preserved ejection fraction (EF), suggesting that
destabilizing factors of the arrhythmogenic substrate (autonomic modulation)
contribute to its occurrence. Objective To determine baroreflex sensitivity (BRS) in patients with undetermined CD
(GI), arrhythmogenic CD with nonsustained ventricular tachycardia (NSVT)
(GII) and CD with spontaneous sustained ventricular tachycardia (STV)
(GIII), to evaluate its association with the occurrence and complexity of
arrhythmias. Method Forty-two patients with CD underwent ECG and continuous and noninvasive BP
monitoring (TASK force monitor). The following were determined: BRS
(phenylephrine method); heart rate variability (HRV) on 24-h Holter; and EF
(echocardiogram). Results GIII had lower BRS (6.09 ms/mm Hg) as compared to GII (11.84) and GI (15.23).
The difference was significant between GI and GIII (p = 0.01). Correlating
BRS with the density of ventricular extrasystoles (VE), low VE density
(<10/h) was associated with preserved BRS. Only 59% of the patients with
high VE density (> 10/h) had preserved BRS (p = 0.003). Patients with
depressed BRS had higher VE density (p = 0.01), regardless of the EF. The
BRS was the only variable related to the occurrence of SVT (p = 0.028). Conclusion The BRS is preserved in undetermined CD. The BRS impairment increases as
disease progresses, being more severe in patients with more complex
ventricular arrhythmias. The degree of autonomic dysfunction did not
correlate with EF, but with the density and complexity of ventricular
arrhythmias.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Denise Tessariol Hachul
- Mailing Address: Denise Tessariol Hachul, Rua Joaquim Cândido de
Azevedo Marques, 1205, Morumbi. Postal Code: 05688-021, São Paulo, SP - Brazil.
E-mail: ;
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Marques J, Mendoza I, Noya B, Acquatella H, Palacios I, Marques-Mejias M. ECG manifestations of the biggest outbreak of Chagas disease due to oral infection in Latin-America. Arq Bras Cardiol 2013; 101:249-54. [PMID: 23887736 PMCID: PMC4032305 DOI: 10.5935/abc.20130144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/15/2013] [Indexed: 11/29/2022] Open
Abstract
Background Chagas disease affects more than 15 million people worldwide. Although
vector-borne transmission has decreased, oral transmission has become important.
Recently, our group published the clinical and epidemiological characteristics of
the largest outbreak of orally transmitted Chagas disease reported till date.
Objective: To describe electrocardiographic changes occurring in the study
population during the outbreak caused by ingestion of contaminated guava juice.
Methods We evaluated 103 positive cases, of which 76 (74%) were aged ≤ 18 years (average
age: 9.1 ± 3.1 years) and 27 (26%) were aged > 18 years (average age: 46 ± 11.8
years). All patients underwent clinical evaluations and ECG. If the patients had
palpitations or evident alterations of rhythm at baseline, ambulatory ECG
monitoring was performed. Results A total of 68 cases (66%; 53 children and 15 adults) had ECG abnormalities.
Further, 69.7% (53/76) of those aged ≤ 18 years and 56% (15/27) of those aged
>18 years showed some ECG alteration (p = ns). ST-T abnormalities were observed
in 37.86% cases (39/103) and arrhythmias were evident in 28.16% cases (29/103). ST
alterations occurred in 72% of those aged ≤18 years compared with 19% of th ose
aged >18 years (p < 0.0001). Conclusion This study reports the largest number of cases in the same outbreak of acute
Chagas disease caused by oral contamination, with recorded ECGs. ECG changes
suggestive of acute myocarditis and arrhythmias were the most frequent
abnormalities found.
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Affiliation(s)
| | | | | | | | | | - María Marques-Mejias
- Mailing Address: María Marques-Mejias, Calle San Francisco, Qta. Gálata,
Prados del este. Postal Code 1080, Caracas, Miranda. E-mail:
, juan.alberto.marques@gmail.
com
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Bravo Tobar I, Parra F, Nello Pérez C, Rodríguez-Bonfante C, Useche F, Bonfante-Cabarcas R. Prevalence of Trypanosoma cruzi antibodies and inflammatory markers in uncompensated heart failure. Rev Soc Bras Med Trop 2012; 44:691-6. [PMID: 22231242 DOI: 10.1590/s0037-86822011000600008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 07/28/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Heart failure (HF) represents the final stage of chronic chagasic cardiomyopathy (CChC). The diagnosis of CChC is based on the demonstration of anti-Trypanosoma cruzi antibodies (aTcAg) and clinical and epidemiological data. In Venezuela, there are no data about the prevalence of chagasic HF. The aim of this study was to determine the epidemiological, clinical, and inflammatory risk factors associated with seronegative or seropositive HF patients. METHODS We performed a cross-sectional study in the Venezuelan central-west states among a healthy rural population and in patients admitted to the emergency room with uncompensated HF. RESULTS The seroprevalence rates of Trypanosoma cruzi antibodies were 11.2% and 40.1% in the healthy population and in HF patients, respectively. Seropositivity in healthy individuals was associated with age, knowledge on triatomine vectors, and having seen wild reservoirs in the house; in HF patients, with contact with the vector and previous clinical diagnosis of Chagas' disease; and in both groups taken together, with age, knowledge on triatomines, and HF. Seropositive patients had prolonged QRS, decreased ejection fraction, and high serum magnesium, all significant as compared with HF seronegative cases. Left atrium enlargement and ventricular hypertrophy were most frequently observed in HF seronegative patients. CRP, IL6, ILβ1, IL2, and FNTα were elevated in 94.5%, 48%, 17.8%, 13.7%, and 6.9% of HF patients, respectively, but only IL2 levels were associated with chagasic HF. CONCLUSIONS There is a high prevalence of aTcAg in HF patients from the central-west region of Venezuela, and their epidemiological, clinical, and inflammatory features are discreetly different as compared with those of seronegative cases.
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Affiliation(s)
- Iván Bravo Tobar
- Unidade de Bioquímica, Decanato de Ciencias de la Salud, Universidade Centro-Occidental Lisandro Alvarado Barquisimeto, Estado Lara, Venezuela
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Muratore CA, Baranchuk A. Current and emerging therapeutic options for the treatment of chronic chagasic cardiomyopathy. Vasc Health Risk Manag 2010; 6:593-601. [PMID: 20730015 PMCID: PMC2922320 DOI: 10.2147/vhrm.s8355] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Indexed: 12/14/2022] Open
Abstract
Chagas’ disease is an endemic disease in Latin America caused by a unicellular parasite (Trypanosoma cruzi) that affects almost 18 million people. This condition involves the heart, causing heart failure, arrhythmias, heart block, thromboembolism, stroke, and sudden death. In this article, we review the current and emerging treatment of Chagas’ cardiomyopathy focusing mostly on management of heart failure and arrhythmias. Heart failure therapeutical options including drugs, stem cells and heart transplantation are revised. Antiarrhythmic drugs, catheter ablation, and intracardiac devices are discussed as well. Finally, the evidence for a potential role of specific antiparasitic treatment for the prevention of cardiovascular disease is reviewed.
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Affiliation(s)
- Claudio A Muratore
- Department of Cardiology, Arrhythmia Service, Hospital Fernandez, Buenos Aires, Argentina.
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Hidron AI, Gilman RH, Justiniano J, Blackstock AJ, LaFuente C, Selum W, Calderon M, Verastegui M, Ferrufino L, Valencia E, Tornheim JA, O'Neal S, Comer R, Galdos-Cardenas G, Bern C. Chagas cardiomyopathy in the context of the chronic disease transition. PLoS Negl Trop Dis 2010; 4:e688. [PMID: 20502520 PMCID: PMC2872643 DOI: 10.1371/journal.pntd.0000688] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 03/29/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with Chagas disease have migrated to cities, where obesity, hypertension and other cardiac risk factors are common. METHODOLOGY/PRINCIPAL FINDINGS The study included adult patients evaluated by the cardiology service in a public hospital in Santa Cruz, Bolivia. Data included risk factors for T. cruzi infection, medical history, physical examination, electrocardiogram, echocardiogram, and contact 9 months after initial data collection to ascertain mortality. Serology and PCR for Trypanosoma cruzi were performed. Of 394 participants, 251 (64%) had confirmed T. cruzi infection by serology. Among seropositive participants, 109 (43%) had positive results by conventional PCR; of these, 89 (82%) also had positive results by real time PCR. There was a high prevalence of hypertension (64%) and overweight (body mass index [BMI] >25; 67%), with no difference by T. cruzi infection status. Nearly 60% of symptomatic congestive heart failure was attributed to Chagas cardiomyopathy; mortality was also higher for seropositive than seronegative patients (p = 0.05). In multivariable models, longer residence in an endemic province, residence in a rural area and poor housing conditions were associated with T. cruzi infection. Male sex, increasing age and poor housing were independent predictors of Chagas cardiomyopathy severity. Males and participants with BMI =25 had significantly higher likelihood of positive PCR results compared to females or overweight participants. CONCLUSIONS Chagas cardiomyopathy remains an important cause of congestive heart failure in this hospital population, and should be evaluated in the context of the epidemiological transition that has increased risk of obesity, hypertension and chronic cardiovascular disease.
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Affiliation(s)
- Alicia I. Hidron
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Robert H. Gilman
- Asociacion Benefica PRISMA, Lima, Peru
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Justiniano
- Hospital Universitario Japones, Santa Cruz de la Sierra, Bolivia
| | - Anna J. Blackstock
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Atlanta Research and Education Foundation, Decatur, Georgia, United States of America
| | - Carlos LaFuente
- Hospital Universitario Japones, Santa Cruz de la Sierra, Bolivia
| | - Walter Selum
- Hospital Universitario Japones, Santa Cruz de la Sierra, Bolivia
| | - Martiza Calderon
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuela Verastegui
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Eduardo Valencia
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey A. Tornheim
- Mount Sinai School of Medicine, New York, New York, United States of America
| | - Seth O'Neal
- Oregon Health Sciences University, Portland, Oregon, United States of America
| | - Robert Comer
- Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States of America
| | | | - Caryn Bern
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Rocha MOC, Nunes MCP, Ribeiro AL. Morbidity and prognostic factors in chronic chagasic cardiopathy. Mem Inst Oswaldo Cruz 2010; 104 Suppl 1:159-66. [PMID: 19753471 DOI: 10.1590/s0074-02762009000900022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 06/03/2009] [Indexed: 01/05/2023] Open
Abstract
Chagas disease is a pleomorphic clinical entity that has several unique features. The aim of this study is to summarise some of the recent contributions from our research group to knowledge of the morbidity and prognostic factors in Chagas heart disease. A retrospective study suggested that ischaemic stroke associated with left ventricular (LV) apical thrombi is the first clinical manifestation of Chagas disease observed in a large proportion of patients. LV function and left atrial volume (LAV) are independent risk factors for ischaemic cerebrovascular events during follow-up of Chagas heart disease patients. Pulmonary congestion in Chagas-related dilated cardiomyopathy is common but usually mild. Although early right ventricular (RV) involvement has been described, we have shown by Doppler echocardiography that RV dysfunction is evident almost exclusively when it is associated with left ventricle dilatation and functional impairment. In addition, RV dysfunction is a powerful predictor of survival in patients with heart failure secondary to Chagas disease. We have also demonstrated that LAV provides incremental prognostic information independent of clinical data and conventional echocardiographic parameters that predict survival.
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Affiliation(s)
- Manoel Otávio C Rocha
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
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Fernández-Mestre M, Sánchez K, Balbás O, Gendzekhzadze K, Ogando V, Cabrera M, Layrisse Z. Influence of CTLA-4 gene polymorphism in autoimmune and infectious diseases. Hum Immunol 2009; 70:532-5. [DOI: 10.1016/j.humimm.2009.03.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 03/17/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Bestetti RB, Theodoropoulos TAD, Cardinalli-Neto A, Cury PM. Treatment of chronic systolic heart failure secondary to Chagas heart disease in the current era of heart failure therapy. Am Heart J 2008; 156:422-30. [PMID: 18760121 DOI: 10.1016/j.ahj.2008.04.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 04/29/2008] [Indexed: 11/19/2022]
Abstract
The treatment of chronic heart failure secondary to Chagas disease has been based on extrapolation of data achieved in the treatment of non-Chagas disease heart failure. Because beta-blockers decrease the incidence of sudden cardiac death in non-Chagas disease heart failure and sudden cardiac death occurs preferentially in patients with mild Chagas disease heart failure, beta-blockers may be administered first to class I/II patients with Chagas disease heart failure. In advanced Chagas disease heart failure, angiotensin-converting enzyme inhibitor and diuretics may be given at first to compensate for congestive symptoms. After clinical status improvement, beta-blockers should be given at targeted doses, if necessary reducing angiotensin-converting enzyme inhibitor doses. Primary and secondary prevention of sudden cardiac death may be accomplished with implantable cardioverter defibrillators because of the high recurrence of life-threatening arrhythmias despite amiodarone administration. In refractory heart failure, heart transplantation is the treatment of choice.
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Affiliation(s)
- Reinaldo B Bestetti
- Outpatient Cardiomyopathy Service, Division of Cardiology, São José do Rio Preto Medical School, São José do Rio Preto City, Brazil.
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Sánchez-Guillén MDC, López-Colombo A, Ordóñez-Toquero G, Gomez-Albino I, Ramos-Jimenez J, Torres-Rasgado E, Salgado-Rosas H, Romero-Díaz M, Pulido-Pérez P, Pérez-Fuentes R. Clinical forms of Trypanosoma cruzi infected individuals in the chronic phase of Chagas disease in Puebla, Mexico. Mem Inst Oswaldo Cruz 2007; 101:733-40. [PMID: 17160280 DOI: 10.1590/s0074-02762006000700005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 09/13/2006] [Indexed: 11/22/2022] Open
Abstract
In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7%. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA). Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients)--mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients)--left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients)--signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.
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Affiliation(s)
- María Del Carmen Sánchez-Guillén
- Laboratorio de Investigación en Fisiopatología de Enfermedades Cróncas, Centro de Investigación Biomédica de Oriente, IMSS, Puebla, México
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Rodríguez-Bonfante C, Amaro A, García M, Mejías Wohlert LE, Guillen P, Antonio García R, Alvarez N, Díaz M, Cárdenas E, Castillo S, Bonfante-Garrido R, Bonfante-Cabarcas R. Epidemiología de la enfermedad de Chagas en el municipio Andrés Eloy Blanco, Lara, Venezuela: infestación triatomínica y seroprevalencia en humanos. CAD SAUDE PUBLICA 2007; 23:1133-40. [PMID: 17486235 DOI: 10.1590/s0102-311x2007000500015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 07/26/2006] [Indexed: 11/21/2022] Open
Abstract
Se realizó un despistaje serológico y recolección de vectores en cuatro comunidades rurales del municipio Andrés Eloy Blanco, Estado Lara, Venezuela. La muestra fue escogida en forma sistemática y aleatoria basada en conglomerados familiares. Se muestrearon 869 habitantes para determinar anticuerpos anti-Trypanosoma cruzi y anti-Leishmania sp. por inmunofluorescencia indirecta, aceptando como positivo diluciones > a 1:32 para anticuerpos anti-T. cruzi no reactivos para antígenos de Leishmania sp., obteniendo una frecuencia de anticuerpos en la muestra de 6,9% (n = 60); de los cuales 46,66% son femeninos, 53,33% masculinos y 60% mayores de 40 años. Se observó que 5 (8,33%) de los seropositivos eran menores de 10 años y 10 (16,66%) menores de 20 años. Rhodnius prolixus y Panstrongylus geniculatus fueron los triatominos capturados, con índice de infestación de 1,9 y 10,54%, índice de colonización, del 0 y 18,18% en las viviendas infestadas e índice de infección a T. cruzi del 20 y 5,07%, respectivamente. Los resultados sugieren que existe una transmisión activa de la enfermedad de Chagas en el Municipio Andrés Eloy Blanco en las últimas dos décadas y que P. geniculatus está substituyendo a R. prolixus como vector de la enfermedad de Chagas.
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26
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Benchimol-Barbosa P. Noninvasive prognostic markers for cardiac death and ventricular arrhythmia in long-term follow-up of subjects with chronic Chagas' disease. Braz J Med Biol Res 2006. [DOI: 10.1590/s0100-879x2006005000061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- P.R. Benchimol-Barbosa
- Universidade do Estado do Rio de Janeiro, Brasil; Corpo de Bombeiros Militar do Estado do Rio de Janeiro, Brasil
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Sternick EB, Martinelli M, Sampaio R, Sampaio RC, Gerken LM, Teixeira RA, Scarpelli R, Scanavacca M, Nishioka SDO, Sosa E. Sudden cardiac death in patients with chagas heart disease and preserved left ventricular function. J Cardiovasc Electrophysiol 2006; 17:113-6. [PMID: 16426416 DOI: 10.1111/j.1540-8167.2005.00315.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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López L, Arai K, Giménez E, Jiménez M, Pascuzo C, Rodríguez-Bonfante C, Bonfante-Cabarcas R. Las concentraciones séricas de interleucina-6 y proteína C reactiva se incrementan a medida que la enfermedad de Chagas evoluciona hacia el deterioro de la función cardíaca. Rev Esp Cardiol 2006. [DOI: 10.1157/13083649] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Carrasco HJ, Torrellas A, García C, Segovia M, Feliciangeli MD. Risk of Trypanosoma cruzi I (Kinetoplastida: Trypanosomatidae) transmission by Panstrongylus geniculatus (Hemiptera: Reduviidae) in Caracas (Metropolitan District) and neighboring States, Venezuela. Int J Parasitol 2005; 35:1379-84. [PMID: 16019006 DOI: 10.1016/j.ijpara.2005.05.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 05/09/2005] [Accepted: 05/09/2005] [Indexed: 10/25/2022]
Abstract
The collection of Panstrongylus geniculatus bugs by inhabitants of dwellings in Caracas city (Metropolitan District) and in the neighboring Miranda and Vargas Sates, Venezuela, allowed for the gathering of data on the potential role of this sylvatic triatomine bug as a vector of Chagas disease in this area. The natural infection by Trypanosoma cruzi was recorded by examining fresh and stained faeces of the bugs. Additionally, a random amplification of polymorphic DNA technique for parasite identification and group typing was employed. A dot-ELISA test was used to identify the gut content of the triatomine bugs with the aim of assessing and quantifying the vector-human contact. Sixty-seven specimens (76.1%) were positive to T. cruzi (identified as T. cruzi I) and 60.2% (53/88) gave a positive reaction to the human antiserum. The human blood-positive samples included mixed blood meals with domestic animals (dog, pig and cow) (9.4%) and with mouse (3.8%). The overall Human Blood Index, measured as the percentage of bugs whose gut contents reacted with human antiserum on the total numbers of bugs that reacted with all the antisera tested, was 98.1%. Almost 41% of the bugs that had fed on humans were also positive for T. cruzi. These data show that the feeding of P. geniculatus on humans does not seem to be accidental and that its rate of infection by T. cruzi is high in this area which is not regarded as endemic for Chagas disease by the National Control Programme. This situation is particularly striking because it occurs in and around Caracas, the capital city, where 20% of the whole population of Venezuela live, human migrations from endemic areas are continuous, people in the crowded shantytown as well as people living in high-quality country houses are equally at risk and the epidemiological cycle Didelphis marsupialis/Rattus rattus-P. geniculatus-human does appear to occur successfully.
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Affiliation(s)
- Hernán J Carrasco
- Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
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Fernández-Mestre MT, Montagnani S, Layrisse Z. Is the CCR5-59029-G/G genotype a protective factor for cardiomyopathy in Chagas disease? Hum Immunol 2005; 65:725-8. [PMID: 15301862 DOI: 10.1016/j.humimm.2004.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Revised: 05/06/2004] [Accepted: 05/10/2004] [Indexed: 01/25/2023]
Abstract
Investigated were two CCR5 gene polymorphisms, the CCR5 Delta 32 deletion and the pCCR5 59029 A-->G promoter point mutation, in 107 ethnically mixed Venezuelan patients serologically positive for Trypanosoma cruzi (34 asymptomatic, 38 arrhythmic, 35 cardiomyopathic). No difference in the distribution of CCR5 Delta 32 among asymptomatic and symptomatic patients was found. We have observed an increase of the 59029-G phenotype among asymptomatic compared with symptomatic chagasic patients (68% vs. 58%), in agreement with previously reported data (57% vs. 31%). This frequency difference, although not statistically significant, is more marked when the 59029-G allele is present in homozygous form. However, a similar distribution of the G/G genotype is present among asymptomatic patients and patients with heart failure. Because it has been reported that the 59029G/G genotype associates with lower CCR5 expression, 37% of our T. cruzi-infected patients with heart failure are genetically predisposed to express low levels of CCR5 on the surface of CD8(+) T cells, contrary to what would be expected if an inflammatory response is required for severe cardiac damage. If confirmed, the possible protection that might be conferred by the G/G genotype may be due to the existence of other genes in linkage disequilibria.
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Affiliation(s)
- M T Fernández-Mestre
- Laboratorio de Fisiopatología, Instituto Venezolano de Investigaciones Científicas, Caracas 1020a, Venezuela
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Dávila DF, Donis JH, Torres A, Ferrer JA. A modified and unifying neurogenic hypothesis can explain the natural history of chronic Chagas heart disease. Int J Cardiol 2004; 96:191-5. [PMID: 15262032 DOI: 10.1016/j.ijcard.2003.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2003] [Revised: 06/02/2003] [Accepted: 06/09/2003] [Indexed: 11/18/2022]
Abstract
The pathogenesis of chronic Chagas disease still is an unresolved and controversial issue. Parasite persistence and autoimmune responses cannot explain the spectrum of chronic Chagas disease. However, a modified neurogenic hypothesis, concerning the timing and mechanisms responsible for the cardiac parasympathetic damage and for the activation of the sympathetic nervous system and of other neurohormonal systems, unifies cardiac remodelling and neurohormonal activation to explain most of the events of the natural history of Chagas disease.
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Affiliation(s)
- Diego F Dávila
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Universidad de Los Andes, Apartado Postal 590, 5101 Mérida, Venezuela.
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Nunes MDCP, Barbosa MDM, Brum VAA, Rocha MODC. Morphofunctional characteristics of the right ventricle in Chagas' dilated cardiomyopathy. Int J Cardiol 2004; 94:79-85. [PMID: 14996479 DOI: 10.1016/j.ijcard.2003.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2002] [Revised: 04/28/2003] [Accepted: 05/01/2003] [Indexed: 01/29/2023]
Abstract
Right ventricular involvement is a typical characteristic of Chagas' disease, and it has been described especially in the early stages of the disease. However, the role of right ventricular dysfunction in cardiac failure due to Chagas' cardiomyopathy has not been well established. Seventy-four patients with positive serology tests for Trypanosoma cruzi and Chagas' dilated cardiomyopathy characterized by left ventricular dilatation and systolic dysfunction were studied. Clinical history, physical exam, ECG, chest X-ray and Doppler echocardiogram with color flow mapping were obtained in all. Mean age was 47.5+/-12.9 and 51 were males (69%). Sixty-five patients (88%) were in NYHA functional classes I and II. Mild systolic dysfunction was present in 35 (47%) while in 18 (24%), dysfunction was moderate and in 21 (28%) it was severe. In 43 patients (58%), only the left ventricle was involved by echocardiographic criteria; the remaining 31 patients (42%) showed biventricular involvement. No patient had isolated involvement of the right ventricle. Greater dilation of the right ventricle was associated with larger diastolic (p<0.002) and systolic (p<0.001) diameters of the left ventricle. Systolic pulmonary artery pressure was obtained non-invasively in 54 patients. Pulmonary hypertension was associated with right ventricular dilation (p<0.005) and with systolic dysfunction of the left ventricle (p<0.001). In this group of patients with Chagas' dilated cardiomyopathy, right ventricular dysfunction was present when there was associated and significant involvement of the left ventricle and with higher levels of pulmonary pressure.
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Abstract
UNLABELLED This study was undertaken to test the hypothesis that ultrasonic tissue characterization, as evaluated by intensity and cardiac cyclic variation of integrated backscatter (IBS), could identify early myocardial involvement in Chagas' disease. We evaluated 69 participants, age 15 to 73 years (mean +/- SD: 49 +/- 12 years), who were divided as following: 19 control subjects; 13 patients with the indeterminate form of Chagas' disease; 7 patients with the digestive form; and 30 patients with the cardiac form. IBS images were obtained in parasternal short-axis (basal, papillary muscle, apical) view and analyzed in 12 left ventricular (LV) segments (anterior, lateral, posterior, and septal). The following IBS variables were evaluated: (1) the corrected coefficient (CC) of IBS, obtained by dividing IBS intensity, in each cardiac segment, by IBS intensity measured in a rubber phantom using the same equipment adjustments at the same depth; and (2) magnitude of cardiac cyclic variation (MCV) of IBS, as measured by the peak-to-peak difference between maximal and minimal values of IBS in cardiac cycle. The CC of IBS was increased (P <.05) for patients with the cardiac form who had LV segments with normal wall motion as compared with control subjects, in 4 of 12 segments evaluated (basal anterior, midposterior and midseptal, anterior apical), whereas the remaining chagasic groups were comparable with controls subjects. The CC of IBS tended to increase with worsening of LV segmental wall motion. MCV showed a large individual variability and had a large mean value (P <.05) in just 1 of 12 segments evaluated, when patients with the cardiac form were compared with control subjects. No correlation was observed between the magnitude of LV dysfunction and MCV of IBS. IN CONCLUSION (1) the CC of IBS was able to provide early differentiation of cardiac involvement for patients with Chagas' disease who had LV segments with normal wall motion; (2) increase of CC of IBS with worsening of LV segmental wall motion suggests a relationship between the acoustic properties of myocardial tissue and grading of myocardial fibrosis; (3) MCV was not able to differentiate patients with Chagas' disease from control subjects; and (4) patients with the indeterminate form of Chagas' disease were not differentiated from control subjects by any of the IBS techniques evaluated in this study.
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Affiliation(s)
- Antônio Pazin-Filho
- Division of Cardiology, Department of Internal Medicine, University Hospital, Medical School of Ribeirão Preto, University of São Paulo, 14048-900 Ribeirão Preto SP, Brazil
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Salles GF, Cardoso CRL, Xavier SS, Sousa AS, Hasslocher-Moreno A. Electrocardiographic ventricular repolarization parameters in chronic Chagas' disease as predictors of asymptomatic left ventricular systolic dysfunction. Pacing Clin Electrophysiol 2003; 26:1326-35. [PMID: 12822748 DOI: 10.1046/j.1460-9592.2003.t01-1-00190.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Electrocardiographic repolarization parameters are potential markers of arrhythmogenic risk and have not been evaluated in Chagas' disease. The aim of this report was to investigate their associations with LV systolic function assessed by two-dimensional echocardiography. In a cross-sectional study involving 738 adult outpatients in the chronic phase of Chagas' disease, maximal QTc and T wave peak-to-end (TpTe) intervals, and QT, QTapex (QTa), IT and TpTe interval dispersions, and variation coefficients were measured and calculated from 12-lead standard ECGs. Clinical, radiological, ECG, and echocardiographic data were recorded. In bivariate statistical analysis, all repolarization parameters were significantly increased in patients with moderate or severe LV systolic dysfunction, and these patients showed more clinical, radiologic, and ECG abnormalities. Receiver operating characteristic curve analysis demonstrated that isolatedly QTd had the best predictive performance for LV dysfunction, with an 80% specificity and 67% sensitivity for values >60 ms in the subgroup of chagasic patients with abnormal ECGs and no heart failure. Multivariate logistic regression selected, as the best predictive model for LV dysfunction in this subgroup of patients, the presence of cardiomegaly on chest X ray (OR 14.06, 95% CI, 5.54-35.71), QTd >60 ms (OR 9.35, 95% CI, 4.01-21.81), male gender (OR 7.70, 95% CI, 2.98-19.91) and the presence of frequent premature ventricular contractions (PVCs) on ECG (OR 4.06, 95% CI, 1.65-9.97). This model showed 90% specificity and 71% sensitivity. In conclusion, QTd was associated to LV systolic function and could be used to predict asymptomatic dysfunction in chronic Chagas' disease. The presence of cardiomegaly, frequent PVCs, and male sex refined LV function stratification in these patients.
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Affiliation(s)
- Gil F Salles
- Department of Internal Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Fernández-Mestre MT, Jaraquemada D, Bruno RE, Caro J, Layrisse Z. Analysis of the T-cell receptor beta-chain variable-region (Vbeta) repertoire in chronic human Chagas' disease. Tissue Antigens 2002; 60:10-5. [PMID: 12366778 DOI: 10.1034/j.1399-0039.2002.600102.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Previous studies have shown that infection with the protozoan Trypanosoma cruzi (Chagas' disease) is associated with genetic components [human leukocyte antigen (HLA) genes and T-cell receptor (TCR) genes]. We studied the TCR Vbeta repertoire of peripheral blood lymphocytes of 23 unrelated serologically positive subjects using reverse transcriptase-polymerase chain reaction (RT-PCR). The patients, previously tested for HLA genotypes, were clinically classified as asymptomatic, arrhythmic and cardiopathic patients. Statistical analysis showed the significant increment of the Vbeta7 family in chagasics with arrhythmia compared with asymptomatic and cardiopathic patients, indicating that the frequency of this family is variable in different clinical forms of the disease and possibly that these T cells might be a marker of the progression of Chagas' disease. Based on the calculation of a Delta score the order of variability in the TCR repertoire was: patients with heart failure > asymptomatic > arrhythmic patients. The major histocompatibility complex (MHC) of the individual may influence the use of particular V genes in T-cell response to foreign antigens. We found a significant increase of the Vbeta7 family in arrhythmic patients who were DRB1*01 DQB1*0501 DPB1*0401, a marker associated with susceptibility to cardiac damage in Chagas' disease. If confirmed by further studies in a larger cohort, a possible association between the TCR Vbeta repertoire and the MHC haplotype of chagasic patients could be postulated.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Alleles
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/metabolism
- Chagas Disease/genetics
- Chagas Disease/metabolism
- Chronic Disease
- Gene Frequency/genetics
- Genotype
- HLA Antigens/genetics
- Heart Failure/genetics
- Heart Failure/metabolism
- Humans
- Leukocytes, Mononuclear/metabolism
- Middle Aged
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Statistics as Topic
- Venezuela
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Affiliation(s)
- M T Fernández-Mestre
- Laboratorio de Fisiopatología, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
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Abstract
The aim of this study was to detect clinical predictors of left ventricular dysfunction, left ventricular dilatation and apical aneurysm on echocardiography, all known as independent predictors of lethal outcome for patients with chronic Chagas' disease. Seventy-four patients with a positive complement-fixation test for Chagas' disease participated; 44 (59%) had left ventricular dysfunction, 41 (55%) left ventricular dilatation and 15 (20%) apical aneurysm. A stepwise logistic regression analysis showed that systolic blood pressure (P < 0.001) and male sex (P < 0.001) were independent predictors of left ventricular dilatation on echocardiography. A receiver-operating characteristic curve provided a systolic blood pressure of 120 mmHg with a sensitivity of 70% and a specificity of 63% to predict left ventricular dilatation. The combination of male sex and systolic blood pressure of 120 mmHg had a sensitivity of 56% and a specificity of 91% to predict left ventricular dilatation. In a separate stepwise logistic regression analysis, left ventricular systolic dysfunction was independently predicted by systolic blood pressure (P = 0.006) and New York Heart Association functional class (P = 0.01). Receiver-operating curves provided a blood pressure of 120 mmHg with a sensitivity of 72% and a specificity of 59% to predict left ventricular dysfunction, whereas a New York Heart Association functional score of 2 predicted left ventricular systolic dysfunction with a sensitivity of 78% and a specificity of 50%. The combination of New York Heart Association functional class and a systolic blood pressure of 120 mmHg predicted left ventricular dysfunction with a sensitivity of 59% and a specificity of 77%. The apical aneurysm was independently predicted by myocardial necrosis on the resting ECG, but only with a sensitivity of 20%. Hence, echocardiographic markers of cardiac mortality and sudden cardiac death in Chagas' disease can be independently predicted by clinical examination. This may be useful for screening high-risk chagasic patients.
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Affiliation(s)
- R B Bestetti
- Faculdade de Medicina Barão de Mauá, Ribeirão Preto City, and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto City, Brazil.
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Abstract
The interruption of vectorial transmission of Chagas disease in Venezuela is attributed to the combined effects of ongoing entomoepidemiological surveillance, ongoing house spraying with residual insecticides and the concurrent building and modification of rural houses in endemic areas during almost five decades. The original endemic areas which totaled 750,000 km(2), have been reduced to 365,000 km(2). During 1958-1968, initial entomological evaluations carried out showed that the house infestation index ranged between 60-80%, the house infection index at 8-11% and a house density index of 30-50 triatomine bugs per house. By 1990-98, these indexes were further reduced to 1.6-4.0%, 0.01-0.6% and 3-4 bugs per house respectively. The overall rural population seroprevalence has declined from 44.5% (95% C.I.: 43.4-45.3%) to 9.2% (95% C.I.: 9.0-9.4%) for successive grouped periods from 1958 to 1998. The annual blood donor prevalence is firmly established below 1%. The population at risk of infection has been estimated to be less than four million. Given that prevalence rates are stable and appropriate for public health programmes, consideration has been given to potential biases that may distort results such as: a) geographical differences in illness or longevity of patients; b) variations in levels of ascertainment; c) variations in diagnostic criteria; and d) variations in population structure, mainly due to appreciable population migration. The endemic areas with continuous transmission are now mainly confined to piedmonts, as well as patchy foci in higher mountainous ranges, where the exclusive vector is Rhodnius prolixus. There is also an unstable area, of which landscapes are made up of grasslands with scattered broad-leaved evergreen trees and costal plains, where transmission is very low and occasional outbreaks are reported.
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Affiliation(s)
- A Aché
- División de Epidemiología, Dirección de Endemias Rurales, Malariología, Ministerio de Sanidad y Asistencia Social, Venezuela.
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Layrisse Z, Fernandez MT, Montagnani S, Matos M, Balbas O, Herrera F, Colorado IA, Catalioti F, Acquatella H. HLA-C(*)03 is a risk factor for cardiomyopathy in Chagas disease. Hum Immunol 2000; 61:925-9. [PMID: 11053636 DOI: 10.1016/s0198-8859(00)00161-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies have shown the effect of class 1 as detected by serology or class 2 HLA genes by oligotyping upon susceptibility or resistance to the cardiomyopathy that develops in approximately one third of the Trypanosoma cruzi chronically infected patients. Low and intermediate resolution DNA typing of class 1 alleles was performed in a sample of 113 serologically positive individuals with and without cardiomyopathy. A polymerase chain reaction-sequence-specific oligonucleotide probe method using primers and probes from the British Society of Histocompatibility and Immunogenetics as modified for the VII Latin American Histocompatibility Workshop by D. Middleton, and LiPA kits from Innogenetics were used. Several alleles (A(*)11, A(*)31, B(*)15, B(*)35, B(*)45, B(*)49, B(*)51, and C(*)03) showed increased frequencies among patients with cardiac damage versus the asymptomatic group, but only the last one remained significant after correction of the p value (OR = 5.8, p(c) = 0.03). HLA-C(*)03 showed linkage disequilibrium with B(*)40 and B(*)15 and although both haplotypes were increased in cardiopathic patients compared with asymptomatic individuals, the difference is not significant. These results suggest that the HLA-C*03 allele could confer susceptibility to the development of cardiomyopathy among Venezuelan T. cruzi seropositive individuals and contrast with the protective effect conferred by the HLA B40 Cw3 haplotype among Chilean chagasic patients. Further studies will be needed to confirm the role of this allele on the cardiomyopathy of Chagas disease.
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Affiliation(s)
- Z Layrisse
- Instituto Venezolano de Investigaciones Científicas, Centro de Medicina Experimental, Laboratorio de Fisiopatología, Caracas, Venezuela.
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Colorado IA, Acquatella H, Catalioti F, Fernandez MT, Layrisse Z. HLA class II DRB1, DQB1, DPB1 polymorphism and cardiomyopathy due to Trypanosoma cruzi chronic infection. Hum Immunol 2000; 61:320-5. [PMID: 10689123 DOI: 10.1016/s0198-8859(99)00177-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Trypanosomiasis is an important cause of cardiomyopathy in endemic rural areas of Latin America. Previous studies have suggested participation of HLA molecules in the immune response regulation of T. cruzi infection, and association of HLA antigens with heart damage. One hundred and eleven unrelated T. cruzi antigen-seropositive individuals were tested for HLA class II alleles by the polymerase chain reaction and sequence specific oligonucleotide (PCR-SSO) method. Patients were classified in 3 groups according to clinical and electrocardiographic characteristics: asymptomatics (group A), with arrhythmia (group B), and with overt congestive heart failure (group C). Statistical analysis confirmed the significant increment of the DRB1*01 DQB1*0501 haplotype (p = 0.03) previously reported by our laboratory in patients with cardiomyopathy. The DPB1*0401 allele frequency is also significantly increased in patients with heart disease (groups B + C) (p = 0.009) while DPB1*0101 frequency is higher among the asymptomatic group (p = 0.04) compared with individuals of group C. The DPB1*0401 allele in homozygous form or in combination with allele DPB1*2301 or 3901, was found present more often in patients of groups B and C. Thus, the combination of two of these three alleles, sharing specific sequence motifs in positions 8, 9, 76, and 84-87 confers a relative risk of 6.55 to develop cardiomyopathy in seropositive patients (p = 0.041). Furthermore, 32% of the cardiomyopathics have either DRB1*01 DQB1*0501 and/or DPB1*0401/*0401, 0401/*2301, or* 0401/*3901 compared with 9% of the seropositive asymptomatics (OR = 5.0; p = 0.006).
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Affiliation(s)
- I A Colorado
- Instituto Venezolano de Investigaciones Cientificas (IVIC), Laboratorio de Fisiopatologia, Caracas and Centro de Investigaciones Jose Francisco Torrealba, San Juan de Los Morros, Venezuela
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Abstract
The autonomic nervous system is abnormal in patients with advanced Chagas' heart disease. Most researchers consider these autonomic abnormalities as primary, specific and irreversible. However, when and why these abnormalities appear in the natural history of Chagas' disease, is still the subject of intense controversy. Recent morphological and functional studies strongly suggest that the sympathetic and the parasympathetic abnormalities are preceded by myocardial damage and left ventricular dysfunction. Moreover, chagasic patients with cardiac failure benefit from drugs which antagonize neurohumoral activation. Consequently, the abnormalities of the autonomic nervous system of chagasic patients are very likely secondary and partially reversible.
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Affiliation(s)
- D F Dávila
- Centro de Investigaciones Cardiovasculares, Universidad de los Andes, Merida, Venezuela
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Abstract
Myocarditis is the end result of a heterogeneous group of conditions which cause inflammation of the myocardium. The resulting myocardial dysfunction may be responsible for significant morbidity and reduced life expectancy of the survivors. The condition is difficult to diagnose and treatment is on the whole rather unsatisfactory. Further work is undoubtedly required to identify methods for early identification of the condition and to develop better therapies aimed at preventing progression to chronic heart failure.
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Affiliation(s)
- A Brodison
- Regional Cardiothoracic Department, Blackpool Victoria Hospital, U.K
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Abstract
The indeterminate form of Chagas' disease is defined by the absence of clinical, radiological and electrocardiographic manifestations of cardiac or digestive involvement in Trypanosoma cruzi chronic infected persons. When submitted to advanced cardiovascular tests, these patients may present significant abnormalities. However, the indeterminate form concept was reaffirmed as valid, since diagnostic criteria are simple and prognosis is benignant. In clinical practice, diagnostic difficulties are frequent, related to subjectivity and uncertain meaning of clinical, electrocardiographic and radiological findings. Moreover, indeterminate form prognosis is not equally good: after five to 10 years, a third of patients will have cardiopathy. Sudden death, a rare complication, may be the first manifestation of Chagas' disease. It is necessary to reappraise indeterminate form concept, redefining diagnostic criteria and therapeutic management. Clinical and noninvasive evaluation may allow individual risk stratification; therapeutic interventions may be beneficial in high risk groups. Since etiologic treatment may prevent cardiopathy, its role in indeterminate form management must be reassessed.
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Affiliation(s)
- A L Ribeiro
- Hospital das Clínicas e na Faculdade de Medicina da Universidade Federal de Minas Gerais.
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Rodriguez-Salas LA, Klein E, Acquatella H, Catalioti F, Davalos V, Gomez-Mancebo JR, Gonzalez H, Bosch F, Puigbo JJ. Echocardiographic and Clinical Predictors of Mortality in Chronic Chagas' Disease. Echocardiography 1998; 15:271-278. [PMID: 11175040 DOI: 10.1111/j.1540-8175.1998.tb00607.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: In a prospective epidemiological study of chronic Chagas' disease, several clinical and echocardiographic variables were analyzed as predictors of mortality. METHODS: Among 960 subjects seropositive for Chagas' disease who were examined between June 1981 and June 1992, 283 had echocardiograms. RESULTS: During a mean follow-up period of 48.3 +/- 36.4 months (range, 1-156 months), 108 subjects died. Echocardiographic end-diastolic and -systolic left ventricular internal dimensions, fractional shortening, radius-to-thickness ratio, left ventricular mass, mitral E-point septal separation, and 17 other nonechocardiographic variables were predictors of death on univariate analysis (P < 0.001 for each). On stepwise multiple regression analysis of 215 subjects, significant risk covariates in a Cox model analysis were clinical group (P < 0.0001), M-mode echocardiographic E-point septal separation of 22 mm (P = 0.003), presence of first- or second-degree heart block (P = 0.003), chest radiologic cardiothoracic ratio >/= 0.55 (P = 0.012), presence of electrocardiographic ST segment elevation on precordial leads (P = 0.014), age >/= 56 years (P = 0.028), and presence of right bundle-branch block (P = 0.045). Patients with an apical aneurysm on two-dimensional echocardiography had an increased mortality (Chi-square = 11.5, P < 0.001). CONCLUSIONS: Echocardiography is a valuable tool to assess the risk of death in prospective studies on chronic Chagas' heart disease.
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Abstract
INTRODUCTION AND OBJECTIVES Chronic Chagas' heart disease is an important public health problem in Latin America. Rural migration from endemic to nonendemic countries has aroused widespread interest (United States, Spain) because of the possibility of observing affected patients. METHODS Review of recent literature. RESULTS The diagnosis of Chagas' cardiomyopathy is based on the triad of epidemiological history, positive serology and the clinical Chagas' syndrome. About 75% of asymptomatic seropositive subjects had no or almost no heart damage but the disease could be transmitted by blood donation. The other 25% may develop arrhythmias, heart failure and/or embolisms. Specific parasiticidal drugs are mainly used in the acute phase. CONCLUSIONS In countries where Chagas' disease is infrequent, patients may be inadvertently diagnosed as having primary dilated or ischemic cardiomyopathy. Disease reactivation in immunodepressed patients due to AIDS, chemotherapy for cancer or for organ transplantation constitutes a formidable clinical challenge. Sanitary prophylactic measures are the strategies of choice.
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Affiliation(s)
- H Acquatella
- Centro de Investigaciones Chagas J.F. Torrealba, Hospital Universitario de Caracas y Centro Médico, Venezuela.
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Affiliation(s)
- R B Bestetti
- Health Service of the University of São Paulo at Ribeirão Preto, Brazil
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46
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Abstract
Gastrointestinal dysfunction is a major problem for many patients with chronic Chagas' disease, as are cardiac dysrhythmias and cardiomyopathy. The underlying anatomic abnormality in these patients is a denervation of the gastrointestinal tract. This process of nerve destruction usually develops insidiously over many years, and it is highly variable in terms of its extent in individual patients as well as in the segments of the gastrointestinal tract that are most affected. Megaesophagus is the most common manifestation of gastrointestinal Chagas disease, and mechanical dilation of the esophageal sphincter or surgery in advanced cases usually give satisfactory relief of symptoms. Megacolon, particularly of the sigmoid segment, is also common in patients with chronic T. cruzi infections, and its presence can be complicated by fecal impaction or sigmoid volvulus. Patients with advanced megacolon who have resections of the sigmoid colon and most of the rectum generally do well postoperatively.
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Affiliation(s)
- L V Kirchhoff
- Division of Infectious Diseases, University of Iowa, Iowa City, USA
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47
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Abstract
In patients with IDCM and sustained VT, every effort should be made to exclude bundle branch reentrant tachycardia. We strongly believe that this mechanism of VT remains underdiagnosed despite electrophysiologic evaluation. In appropriate candidates with cardiomyopathies and "nonbundle branch reentrant VT," ICD implantation is frequently the treatment of choice, especially if the clinical presentation is that of hemodynamic collapse, or there is significant left ventricular systolic dysfunction. The role of amiodarone versus ICD, especially for patients with well-tolerated VT and milder forms of cardiomyopathies, is yet to be defined.
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Affiliation(s)
- Z Blanck
- Electrophysiology Laboratory, Milwaukee Heart Institute of Sinai Samaritan Medical Center, Wisconsin, USA
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49
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Abstract
Symptoms of myocardial ischemia, such as chest pain (sometimes with anginal features), acute myocardial infarction, and segmental wall motion abnormalities (including left ventricular apical aneurysm), frequently occur in patients with Chagas' heart disease. Because these clinical findings occur in the presence of normal coronary arteries, it is possible that an abnormality of the coronary vascular reactivity could be present in these patients. Therefore the current study was undertaken to determine whether endothelium-dependent coronary vasodilation is abnormal in Chagas' heart disease. Coronary endothelial function was assessed by infusing the endothelium-dependent vasodilator acetylcholine (10(-8) to 10(-6) mol/L) and the endothelium-independent vasodilator adenosine (10(-4) mol/L) into the left anterior descending coronary artery of nine patients (age 43 +/- 4 years) with Chagas' heart disease. Coronary blood flow was measured with a Doppler flow velocity catheter and by quantitative coronary cineangiography. The left ventricular ejection fraction was 39% +/- 5%; eight patients had a left ventricular apical aneurysm; and one had an area of anteroapical hypokinesis. An impairment of the endothelium-dependent coronary vasodilation was demonstrated by a reduction in coronary blood flow of 41.2% +/- 12.8% produced by the infusion of acetylcholine at 10(-6) mol/L and by a blunted but preserved increase in coronary blood flow of 114.6% +/- 65.0% with the infusion of adenosine at 10(-4) mol/L (p = 0.03). In conclusion, patients with Chagas' heart disease have an abnormality of the coronary endothelium-dependent vasodilation, and this abnormality may play a role in their chest pain syndrome and in the development of segmental wall motion abnormalities.
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Affiliation(s)
- F W Torres
- Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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Carrasco HA, Parada H, Guerrero L, Duque M, Durán D, Molina C. Prognostic implications of clinical, electrocardiographic and hemodynamic findings in chronic Chagas' disease. Int J Cardiol 1994; 43:27-38. [PMID: 8175216 DOI: 10.1016/0167-5273(94)90087-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To evaluate the prognostic importance of 19 clinical, electrocardiographic and hemodynamic variables, 556 chronic chagasic patients were submitted to an extensive protocol, including left cineventriculogram and Holter monitoring, and followed for up to 15 years. The protagonist role of the magnitude of the myocardial compromise in the evolution of chagasic patients is underscored by our results, which indicated the independent prognostic value of an ejection fraction below 0.30 (P < 0.001), a heart rate higher than 89 beats/min (P < 0.01), grade IV functional capacity (P < 0.05), end systolic stress > 120 g/cm2 (P < 0.05), and end diastolic volume index > 200 ml/m2 (P < 0.05). When only patients with an ejection fraction over 0.29 were considered, variables with independent prognostic value were: the cardio-thoracic ratio (P < 0.01), functional capacity (P < 0.05) and heart rate (P < 0.05). Survival analysis demonstrated that the presence of complex (Lown III, IV) ventricular arrhythmias increased mortality significantly (P < 0.01) only in patients with an ejection fraction over 0.29. Therefore, preservation of myocardial function is the capital measure in the treatment of chronic chagasic patients.
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Affiliation(s)
- H A Carrasco
- Centro de Investigaciones Cardiovasculares Dr Abdel Fuenmayor, Universidad de Los Andes, Mérida, Venezuela
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