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Sabino EC, Nunes MCP, Blum J, Molina I, Ribeiro ALP. Cardiac involvement in Chagas disease and African trypanosomiasis. Nat Rev Cardiol 2024:10.1038/s41569-024-01057-3. [PMID: 39009679 DOI: 10.1038/s41569-024-01057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/17/2024]
Abstract
Trypanosomiases are diseases caused by various species of protozoan parasite in the genus Trypanosoma, each presenting with distinct clinical manifestations and prognoses. Infections can affect multiple organs, with Trypanosoma cruzi predominantly affecting the heart and digestive system, leading to American trypanosomiasis or Chagas disease, and Trypanosoma brucei primarily causing a disease of the central nervous system known as human African trypanosomiasis or sleeping sickness. In this Review, we discuss the effects of these infections on the heart, with particular emphasis on Chagas disease, which continues to be a leading cause of cardiomyopathy in Latin America. The epidemiology of Chagas disease has changed substantially since 1990 owing to the emigration of over 30 million Latin American citizens, primarily to Europe and the USA. This movement of people has led to the global dissemination of individuals infected with T. cruzi. Therefore, cardiologists worldwide must familiarize themselves with Chagas disease and the severe, chronic manifestation - Chagas cardiomyopathy - because of the expanded prevalence of this disease beyond traditional endemic regions.
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Affiliation(s)
- Ester Cerdeira Sabino
- Department of Pathology, Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Maria Carmo P Nunes
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Luiz P Ribeiro
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Moreira HT, Volpe GJ, Mesquita GM, Braggion-Santos MF, Pazin-Filho A, Marin-Neto JA, Schmidt A. Association of left ventricular abnormalities with incident cerebrovascular events and sources of thromboembolism in patients with chronic Chagas cardiomyopathy. J Cardiovasc Magn Reson 2022; 24:52. [PMID: 36329520 PMCID: PMC9632087 DOI: 10.1186/s12968-022-00885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular events and sources of thromboembolism in patients with Chagas cardiomyopathy. METHODS This retrospective cohort included patients with chronic Chagas cardiomyopathy who underwent cardiovascular magnetic resonance (CMR). CMR was performed with a 1.5 T scanner to provide LV volumes, mass, ejection fraction (LVEF), and myocardial fibrosis. The primary outcome was a composite of incident ischemic cerebrovascular events (stroke or transient ischemic attack-TIA) and potential thromboembolic sources (atrial fibrillation (AF), atrial flutter, or intracavitary thrombus) during the follow-up. RESULTS A total of 113 patients were included. Median age was 56 years (IQR: 45-67), and 58 (51%) were women. The median LVEF was 53% (IQR: 41-62). LV aneurysms and LV fibrosis were present in 38 (34%) and 76 (67%) individuals, respectively. The median follow-up time was 6.9 years, with 29 events: 11 cerebrovascular events, 16 had AF or atrial flutter, and two had LV apical thrombosis. In the multivariable model, only lower LVEF remained significantly associated with the outcomes (HR: 0.96, 95% CI: 0.93-0.99). Patients with reduced LVEF lower than 40% had a much higher risk of cerebrovascular events and thromboembolic sources (HR: 3.16 95% CI: 1.38-7.25) than those with normal LVEF. The combined incidence rate of the combined events in chronic Chagas cardiomyopathy patients with reduced LVEF was 13.9 new cases per 100 persons-year. CONCLUSIONS LV systolic dysfunction is an independent predictor of adverse cerebrovascular events and potential sources of thromboembolism in patients with chronic Chagas cardiomyopathy.
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Affiliation(s)
- Henrique Turin Moreira
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Gustavo Marques Mesquita
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Maria Fernanda Braggion-Santos
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Antonio Pazin-Filho
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - André Schmidt
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
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Lage TAR, Tupinambás JT, Pádua LBD, Ferreira MDO, Ferreira AC, Teixeira AL, Nunes MCP. Stroke in Chagas disease: from pathophysiology to clinical practice. Rev Soc Bras Med Trop 2022; 55:e0575. [PMID: 35674560 PMCID: PMC9176734 DOI: 10.1590/0037-8682-0575-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.
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Affiliation(s)
| | | | | | | | | | - Antonio Lucio Teixeira
- Universidade Federal de Minas Gerais, Brasil; University of Texas, United States of America
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Medina-Rincón GJ, Gallo-Bernal S, Jiménez PA, Cruz-Saavedra L, Ramírez JD, Rodríguez MJ, Medina-Mur R, Díaz-Nassif G, Valderrama-Achury MD, Medina HM. Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review. Pathogens 2021; 10:pathogens10111493. [PMID: 34832648 PMCID: PMC8619182 DOI: 10.3390/pathogens10111493] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi’s infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite’s life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.
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Affiliation(s)
- Germán J. Medina-Rincón
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Correspondence: ; Tel.: +57-310-817-2369
| | - Sebastián Gallo-Bernal
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Paula A. Jiménez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Lissa Cruz-Saavedra
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - María Juliana Rodríguez
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Ramón Medina-Mur
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Gustavo Díaz-Nassif
- Division of Gastroenterology and Liver Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 111221, Colombia;
| | | | - Héctor M. Medina
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
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Pino-Marín A, Medina-Rincón GJ, Gallo-Bernal S, Duran-Crane A, Arango Duque ÁI, Rodríguez MJ, Medina-Mur R, Manrique FT, Forero JF, Medina HM. Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death. Pathogens 2021; 10:505. [PMID: 33922366 PMCID: PMC8145478 DOI: 10.3390/pathogens10050505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022] Open
Abstract
Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community's apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host-parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease's clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy's (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.
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Affiliation(s)
- Antonia Pino-Marín
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110131, Colombia; (G.J.M.-R.); (S.G.-B.); (M.J.R.); (J.F.F.); (H.M.M.)
| | - Germán José Medina-Rincón
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110131, Colombia; (G.J.M.-R.); (S.G.-B.); (M.J.R.); (J.F.F.); (H.M.M.)
| | - Sebastian Gallo-Bernal
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110131, Colombia; (G.J.M.-R.); (S.G.-B.); (M.J.R.); (J.F.F.); (H.M.M.)
- Division of Cardiology, Fundación Cardio-Infantil-Instituto de Cardiología, Bogotá 110131, Colombia; (R.M.-M.); (F.T.M.)
| | - Alejandro Duran-Crane
- Internal Medicine Residency Program, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Álvaro Ignacio Arango Duque
- Department of Infectious Diseases, Fundación Cardio-Infantil-Instituto de Cardiología, Bogotá 110131, Colombia;
| | - María Juliana Rodríguez
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110131, Colombia; (G.J.M.-R.); (S.G.-B.); (M.J.R.); (J.F.F.); (H.M.M.)
- Division of Cardiology, Fundación Cardio-Infantil-Instituto de Cardiología, Bogotá 110131, Colombia; (R.M.-M.); (F.T.M.)
| | - Ramón Medina-Mur
- Division of Cardiology, Fundación Cardio-Infantil-Instituto de Cardiología, Bogotá 110131, Colombia; (R.M.-M.); (F.T.M.)
| | - Frida T. Manrique
- Division of Cardiology, Fundación Cardio-Infantil-Instituto de Cardiología, Bogotá 110131, Colombia; (R.M.-M.); (F.T.M.)
| | - Julian F. Forero
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110131, Colombia; (G.J.M.-R.); (S.G.-B.); (M.J.R.); (J.F.F.); (H.M.M.)
- Division of Radiology, Fundación Cardio-Infantil-Instituto de Cardiología, Bogotá 110131, Colombia
| | - Hector M. Medina
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110131, Colombia; (G.J.M.-R.); (S.G.-B.); (M.J.R.); (J.F.F.); (H.M.M.)
- Division of Cardiology, Fundación Cardio-Infantil-Instituto de Cardiología, Bogotá 110131, Colombia; (R.M.-M.); (F.T.M.)
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Arruda HMBDSD, Ribeiro MA, Silva AMD, Vasconcelos D, Oliveira MRFD, Noronha EF. Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease. Rev Soc Bras Med Trop 2019; 52:e20180541. [DOI: 10.1590/0037-8682-0541-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 11/05/2019] [Indexed: 11/21/2022] Open
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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] [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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de Paiva Bezerra R, de Miranda Alves MA, Conforto AB, Rodrigues DLG, Silva GS. Etiological Classification of Stroke in Patients with Chagas Disease Using TOAST, Causative Classification System TOAST, and ASCOD Phenotyping. J Stroke Cerebrovasc Dis 2017; 26:2864-2869. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022] Open
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Nunes MCP, Kreuser LJ, Ribeiro AL, Sousa GR, Costa HS, Botoni FA, de Souza AC, Gomes Marques VE, Fernandez AB, Teixeira AL, da Costa Rocha MO. Prevalence and risk factors of embolic cerebrovascular events associated with Chagas heart disease. Glob Heart 2016; 10:151-7. [PMID: 26407510 DOI: 10.1016/j.gheart.2015.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/07/2015] [Accepted: 07/16/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with Chagas disease are at increased risk for stroke that may result in major clinical disability and death. Identification of risk factors involved in the genesis of thromboembolic events related to this disease may lead to improved therapeutic decision making and outcomes. OBJECTIVES This study sought to assess the prevalence of ischemic cerebrovascular events (ICE) among patients with Chagas heart disease and to identify the risk factors associated with cardioembolism in this population. METHODS This study involved 330 patients, 193 were men (58%), with a mean age of 49 ± 12 years with Chagas disease classified in the chronic cardiac form of the disease. Comprehensive echocardiography was performed to search a substrate for cardioembolic events, especially apical aneurysm and intracavitary thrombus. RESULTS Most of the patients were classified as New York Heart Association classes I or II (75%) with mean left ventricular (LV) ejection fraction of 39 ± 14%. Sixty-seven patients had a previous ICE with the overall prevalence of 20%. Apical aneurysms were detected in 128 patients (39%), whereas LV mural thrombi were found in 48 patients (15%). In multivariate analysis including the potential predictors of ICE, apical aneurysm (adjusted odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.11 to 4.34; p = 0.024) and LV thrombus (adjusted OR: 2.43, 95% CI: 1.09 to 5.42; p = 0.030) emerged as important determinants of ICE, after adjusting for anticoagulation therapy. CONCLUSIONS In a selected population referred to a tertiary center for Chagas disease that included patients with different severities of cardiac involvement, the prevalence of ICE was 20%. The presence of apical aneurysm and intracavitary thrombus were independently associated with ICE, after adjustment for other risk factors for stroke.
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Affiliation(s)
- Maria Carmo P Nunes
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | | | - Antonio Luiz Ribeiro
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Giovane Rodrigo Sousa
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Silveira Costa
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando Antonio Botoni
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Cristina de Souza
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vitoria Emilia Gomes Marques
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Antonio Lucio Teixeira
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Manoel Otávio da Costa Rocha
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Tanowitz HB, Machado FS, Spray DC, Friedman JM, Weiss OS, Lora JN, Nagajyothi J, Moraes DN, Garg NJ, Nunes MCP, Ribeiro ALP. Developments in the management of Chagas cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 13:1393-409. [PMID: 26496376 DOI: 10.1586/14779072.2015.1103648] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over 100 years have elapsed since the discovery of Chagas disease and there is still much to learn regarding pathogenesis and treatment. Although there are antiparasitic drugs available, such as benznidazole and nifurtimox, they are not totally reliable and often toxic. A recently released negative clinical trial with benznidazole in patients with chronic Chagas cardiomyopathy further reinforces the concerns regarding its effectiveness. New drugs and new delivery systems, including those based on nanotechnology, are being sought. Although vaccine development is still in its infancy, the reality of a therapeutic vaccine remains a challenge. New ECG methods may help to recognize patients prone to developing malignant ventricular arrhythmias. The management of heart failure, stroke and arrhythmias also remains a challenge. Although animal experiments have suggested that stem cell based therapy may be therapeutic in the management of heart failure in Chagas cardiomyopathy, clinical trials have not been promising.
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Affiliation(s)
- Herbert B Tanowitz
- a Department of Pathology , Albert Einstein College of Medicine , Bronx , NY , USA.,b Department of Medicine , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Fabiana S Machado
- c Department of Biochemistry and Immunology, Institute of Biological Science , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,d Program in Health Sciences: Infectious Diseases and Tropical Medicine, Medical School , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - David C Spray
- b Department of Medicine , Albert Einstein College of Medicine , Bronx , NY , USA.,e Dominick P. Purpura Department of Neuroscience , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Joel M Friedman
- f Department of Physiology & Biophysics , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Oren S Weiss
- a Department of Pathology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Jose N Lora
- a Department of Pathology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Jyothi Nagajyothi
- g Public Health Research Institute, New Jersey Medical School , Rutgers University , Newark , NJ , USA
| | - Diego N Moraes
- d Program in Health Sciences: Infectious Diseases and Tropical Medicine, Medical School , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,h Department of Internal Medicine and University Hospital , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Nisha Jain Garg
- i Department of Microbiology & Immunology and Institute for Human Infections and Immunity , University of Texas Medical Branch , Galveston , TX , USA
| | - Maria Carmo P Nunes
- d Program in Health Sciences: Infectious Diseases and Tropical Medicine, Medical School , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,h Department of Internal Medicine and University Hospital , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Antonio Luiz P Ribeiro
- d Program in Health Sciences: Infectious Diseases and Tropical Medicine, Medical School , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,h Department of Internal Medicine and University Hospital , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
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Cardioembolic sources in stroke patients in South of Brazil. THROMBOSIS 2014; 2014:753780. [PMID: 25349734 PMCID: PMC4198824 DOI: 10.1155/2014/753780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022]
Abstract
Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.
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