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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: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [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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Silva LEV, Moreira HT, de Oliveira MM, Cintra LSS, Salgado HC, Fazan R, Tinós R, Rassi A, Schmidt A, Marin-Neto JA. Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score. Biomed Eng Online 2022; 21:44. [PMID: 35765063 PMCID: PMC9241264 DOI: 10.1186/s12938-022-01014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Dysautonomia plays an ancillary role in the pathogenesis of Chronic Chagas Cardiomyopathy (CCC), but is the key factor causing digestive organic involvement. We investigated the ability of heart rate variability (HRV) for death risk stratification in CCC and compared alterations of HRV in patients with isolated CCC and in those with the mixed form (CCC + digestive involvement). Thirty-one patients with CCC were classified into three risk groups (low, intermediate and high) according to their Rassi score. A single-lead ECG was recorded for a period of 10–20 min, RR series were generated and 31 HRV indices were calculated. The HRV was compared among the three risk groups and regarding the associated digestive involvement. Four machine learning models were created to predict the risk class of patients. Results Phase entropy is decreased and the percentage of inflection points is increased in patients from the high-, compared to the low-risk group. Fourteen patients had the mixed form, showing decreased triangular interpolation of the RR histogram and absolute power at the low-frequency band. The best predictive risk model was obtained by the support vector machine algorithm (overall F1-score of 0.61). Conclusions The mixed form of Chagas' disease showed a decrease in the slow HRV components. The worst prognosis in CCC is associated with increased heart rate fragmentation. The combination of HRV indices enhanced the accuracy of risk stratification. In patients with the mixed form of Chagas disease, a higher degree of sympathetic autonomic denervation may be associated with parasympathetic impairment.
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Affiliation(s)
- Luiz Eduardo Virgilio Silva
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Henrique Turin Moreira
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Marina Madureira de Oliveira
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Lorena Sayore Suzumura Cintra
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Helio Cesar Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rubens Fazan
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Renato Tinós
- Department of Computing and Mathematics, Ribeirão Preto School of Philosophy, Science and Literature, University of São Paulo, Ribeirão Preto, Brazil
| | | | - André Schmidt
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - J Antônio Marin-Neto
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14048-900, Brazil.
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Oliveira MARD, Nascimento TA, Feitosa-Filho GS, Ritt LEF, Cruz CMS, Rocha MDS. Dysautonomia Evaluation by Holter in Chagas Heart Disease. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20200405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Marin-Neto JA, Rassi Jr A. The challenge of risk assessment in the riddle of Chagas heart disease. Mem Inst Oswaldo Cruz 2022; 117:e210172chgsb. [PMID: 35674530 PMCID: PMC9172882 DOI: 10.1590/0074-02760210172chgsb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Anis Rassi Jr
- Diretor Científico do Hospital do Coração Anis Rassi, Brasil
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Martins Barros IM, Barros MVL, Almeida Martins LN, Ribeiro ALP, de Camargo RSS, Oliveira CDL, Ferreira AM, de Oliveira LC, Bierrenbach AL, Haikal DS, Sabino EC, Cardoso CS, Nunes MCP. Accuracy and reliability of focused echocardiography in patients with Chagas disease from endemic areas: SaMi-Trop cohort study. PLoS One 2021; 16:e0258767. [PMID: 34735475 PMCID: PMC8568132 DOI: 10.1371/journal.pone.0258767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chagas disease remains a major cause of cardiovascular death in endemic areas. Focused echocardiography (FoCUS) is a point-of-care means of assessing cardiac function which can be useful for the diagnosis of cardiac involvement. OBJECTIVE This study aims evaluating the characteristics of validity and reliability of FoCUS applied on Chagas disease patients. METHODS Patients with Chagas disease coming from an endemic area were selected from a large cohort (SaMi-Trop). A simplified echocardiogram with only three images was extracted from the conventional echocardiogram performed in this cohort. The images were evaluated by an observer who was blinded to the clinical and echocardiographic data, to determine the accuracy and reliability of FoCUS for cardiac assessment. The analysis constituted of 5 prespecified variables, dichotomized in absence or presence: left ventricular (LV) size and systolic function, right ventricular (RV) size and systolic function, and LV aneurysm. RESULTS We included 725 patients with a mean age of 63.4 ± 12.3 years, 483 (67%) female. Abnormal electrocardiogram was observed in 81.5% of the patients. Left and right ventricular dysfunctions were found in 103 (14%) and 49 (7%) of the patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 84%, 94%, 70% and 97% for LV enlargement and 81%, 93%, 68% and 97% for LV systolic dysfunction, respectively, and 46%, 99%, 60% and 98% for RV dilatation, and 37%, 100%, 100% and 96% for RV dysfunction, respectively. Inter and intraobserver agreement were 61% and 87% for LV enlargement and 63% and 92% for LV dysfunction, respectively, and 50% and 49% for RV size and 46% and 79% for RV dysfunction, respectively. LV apical aneurysm was found in 45 patients (6.2%) with the lowest sensitivity of FoCUS study (11%; 95% CI 2-28%). CONCLUSIONS FoCUS showed satisfactory values of validity and reliability for assessment of cardiac chambers in patients with Chagas disease, except for apical aneurysm. This tool can identify heart disease with potential impact on patient management in the limited-resource setting.
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Affiliation(s)
- Isabella Morais Martins Barros
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marcio Vinicius L. Barros
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Antonio Luiz P. Ribeiro
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Ariela Mota Ferreira
- Health Science Program, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | - Lea Campos de Oliveira
- Laboratório de Investigação Médica (LIM03), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical e Departamento de Moléstias Infecciosas e Parasitarias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Maria Carmo Pereira Nunes
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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de Freitas Silva E, Cardinalli-Neto A, Grassi LV, Nogueira PR, Bestetti RB. Noninvasive prediction of late potentials in the signal-averaged ECG in patients with chronic Chagas disease. J Electrocardiol 2021; 69:55-59. [PMID: 34563890 DOI: 10.1016/j.jelectrocard.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Considering the importance of ventricular arrhythmias in the prediction of sudden cardiac death in chronic Chagas heart disease, the aim of the present study was to associate late potentials observed in the signal-averaged electrocardiogram (SAECG) with either non-sustained ventricular tachycardia in the 24-hour Holter monitoring or reduced left ventricular ejection fraction in the 2-dimension echocardiogram. METHODS This was a retrospective transversal study. The medical charts of 49 patients with chronic Chagas heart disease that underwent 24-hour Holter monitoring at our institution from September 2012 to December 2015 were reviewed. In the univariate analysis, variables associated with SAECG at a p value <0.05 were entered a multivariate stepwise logistic regression analysis through the model forward. A p value <0.05 was considered to have statistical significance. RESULTS In the univariate analysis, right bundle branch block, left atrial diameter, left ventricular systolic diameter, and left ventricular ejection fraction were associated with late potential in the SAECG. In the multivariate analysis, however, right bundle branch block and left atrial diameter were retained as independent predictors of late potentials in the SAECG. CONCLUSIONS Neither ventricular arrhythmias in the 24-Holter monitoring nor reduced left ventricular ejection fraction in the 2-D echocardiogram were associated with late potentials in the SAECG of patients with chronic Chagas heart disease.
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Affiliation(s)
- Elissandro de Freitas Silva
- Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil, 5544, Brigadeiro Faria Lima Avenue, São José do Rio Preto, São Paulo 15090-000, Brazil
| | - Augusto Cardinalli-Neto
- Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil, 5544, Brigadeiro Faria Lima Avenue, São José do Rio Preto, São Paulo 15090-000, Brazil
| | - Luciano Vaccari Grassi
- Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil, 5544, Brigadeiro Faria Lima Avenue, São José do Rio Preto, São Paulo 15090-000, Brazil
| | - Paulo Roberto Nogueira
- Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil, 5544, Brigadeiro Faria Lima Avenue, São José do Rio Preto, São Paulo 15090-000, Brazil
| | - Reinaldo Bulgarelli Bestetti
- Postgraduate division of São José do Rio Preto Medical School, São José do Rio Preto, Brazil, 5416, Brigadeiro Faria Lima Avenue, São José do Rio Preto, São Paulo 15090-000, Brazil.
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A New Hysteroscopic Scoring System for Diagnosing Chronic Endometritis. J Minim Invasive Gynecol 2020; 27:1127-1132. [PMID: 32240839 DOI: 10.1016/j.jmig.2019.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To develop a new hysteroscopic morphologic scoring system to diagnose chronic endometritis (CE). DESIGN Prospective study. SETTING Medical hysteroscopy office. PATIENTS In total, 320 patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies from February 2017 to June 2018 with the intention of undergoing assisted reproductive technology treatment because of infertility or recurrent miscarriage. INTERVENTIONS All patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies for histologic examination and were classified according to the new hysteroscopic morphologic scoring system. MEASUREMENTS AND MAIN RESULTS Of the 320 patients, 164 received a diagnosis of CE by histology (group A), whereas 156 patients were found not to have CE (group B). A total of 116 patients were diagnosed by our hysteroscopy scoring system to have CE, and 204 patients did not have CE. The scoring system showed a sensitivity and specificity of 62.8% and 91.7%, respectively. The positive predictive values and negative predictive values were 88.8% and 70.1%, respectively. Receiver operating characteristic analysis showed a cutoff value of >2 and an area under the curve of 0.823. Hysteroscopic and histologic grading showed moderate agreement (κ index = 0.529). CONCLUSION Our hysteroscopic scoring system has a high sensitivity and specificity for CE; it is hoped that its use can reduce interobserver variability. Future clinical studies are warranted to confirm the validity and clinical applicability of the proposed hysteroscopic morphologic scoring system for CE.
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Merejo Peña CM, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Dysautonomy in different death risk groups (Rassi score) in patients with Chagas heart disease. Pacing Clin Electrophysiol 2018; 41:238-245. [PMID: 29315657 DOI: 10.1111/pace.13270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/02/2017] [Accepted: 12/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been difficult to prove that "catecholamine-induced cardiomyopathy" contributes to the mechanism of sudden cardiac death in Chagas heart disease. Also, it is almost impossible to rule out the possibility that it is not involved in the process. More importantly, the vagal-cholinergic pathway in the ventricle plays a direct role in the prevention of the initiation of complex ventricular arrhythmias, including nonsustained ventricular tachycardia, ventricular fibrillation responsible for sudden death. OBJECTIVE To determine frequency of parasympathetic autonomic indices among the different groups of risk of cardiovascular death when stratified by Rassi score. METHODS Patients with Chagas heart disease were selected and divided into three risk groups by Rassi score. A fourth group, non-Chagas group, was of similar age and gender. All were subjected to analysis of heart rate variability during controlled breathing (RSA) and tilt table passive test (tilt test). High frequency and low frequency/high frequency ratio were calculated and presented by box-plot. Also, t-test was used to compare the two groups. RESULTS It was observed that the parasympathetic and sympathetic component were affected, when the risk group increased the response was worsened to the stimulus (RSA or Tilt). Also, the low-risk group was jeopardized, when compared to the non-Chagas group. CONCLUSION The loss of parasympathetic modulation was present in all Rassi risk groups, including the low risk, indicating that a morphological change of the myocardium represents a detectable neurofunctional change.
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Affiliation(s)
- Catherine Masiel Merejo Peña
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ.,National Institute of Cardiology (INC) Research Department
| | - Michel Silva Reis
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ
| | - Basílio de Bragança Pereira
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ.,Department of Biostatistics and Applied Statistics, Alberto Luiz Coimbra Institute of Graduate Studies and Research in Engineering, Federal University of Rio de Janeiro
| | - Emília Matos do Nascimento
- Department of Biostatistics and Applied Statistics, Alberto Luiz Coimbra Institute of Graduate Studies and Research in Engineering, Federal University of Rio de Janeiro
| | - Roberto Coury Pedrosa
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ.,Department of Cardiovascular Sciences, University of Leicester, Leicester, England
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Mendes FDSNS, Brasil PEAAD. Prediction Models for Decision-Making on Chagas Disease. Arq Bras Cardiol 2017; 108:470-472. [PMID: 28591323 PMCID: PMC5444894 DOI: 10.5935/abc.20170059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/14/2017] [Indexed: 11/20/2022] Open
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Ianieri MM, Staniscia T, Pontrelli G, Di Spiezio Sardo A, Manzi FS, Recchi M, Liberati M, Ceccaroni M. A New Hysteroscopic Risk Scoring System for Diagnosing Endometrial Hyperplasia and Adenocarcinoma. J Minim Invasive Gynecol 2016; 23:712-8. [DOI: 10.1016/j.jmig.2016.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Cardoso CS, Sabino EC, Oliveira CDL, de Oliveira LC, Ferreira AM, Cunha-Neto E, Bierrenbach AL, Ferreira JE, Haikal DS, Reingold AL, Ribeiro ALP. Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile. BMJ Open 2016; 6:e011181. [PMID: 27147390 PMCID: PMC4861110 DOI: 10.1136/bmjopen-2016-011181] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants. PARTICIPANTS The study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300 pg/mL in 30% of the sample. FINDINGS TO DATE Clinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare. FUTURE PLANS We will continue following this patients' cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities. TRIAL REGISTRATION NUMBER NCT02646943; Pre-results.
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Affiliation(s)
- Clareci Silva Cardoso
- Federal University of São João del-Rei, Brazil
- University of California, Berkeley, California, USA
| | - Ester Cerdeira Sabino
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Lea Campos de Oliveira
- Laboratory of Medicine Laboratorial (LIM03), General Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ariela Mota Ferreira
- Health Science Programme, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Edécio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology, iii-INCT, São Paulo, Brazil
| | - Ana Luiza Bierrenbach
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - João Eduardo Ferreira
- Institute of Mathematics and Statistics (IME), University of São Paulo, São Paulo, Brazil
| | - Desirée Sant'Ana Haikal
- Health Science Programme, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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12
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Veloso HH. Underutilization of implantable cardioverter-defibrillator in studies proposing risk scores to predict death in Chagas heart disease: Just a reflection of the real world. Int J Cardiol 2016; 203:1082-3. [PMID: 26638058 DOI: 10.1016/j.ijcard.2015.11.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Henrique Horta Veloso
- Evandro Chagas National Institute of Infectious Diseases, Fundação Oswaldo Cruz - Fiocruz, Rio de Janeiro, Brazil
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13
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Nasario-Junior O, Benchimol-Barbosa PR, Pedrosa RC, Nadal J. Assessment of Autonomic Function by Phase Rectification of RRInterval Histogram Analysis in Chagas Disease. Arq Bras Cardiol 2015; 104:450-5. [PMID: 26131700 PMCID: PMC4484677 DOI: 10.5935/abc.20150032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/26/2015] [Indexed: 11/20/2022] Open
Abstract
Background In chronic Chagas disease (ChD), impairment of cardiac autonomic function bears
prognostic implications. Phase‑rectification of RR-interval series isolates the
sympathetic, acceleration phase (AC) and parasympathetic, deceleration phase (DC)
influences on cardiac autonomic modulation. Objective This study investigated heart rate variability (HRV) as a function of RR-interval
to assess autonomic function in healthy and ChD subjects. Methods Control (n = 20) and ChD (n = 20) groups were studied. All underwent 60-min
head-up tilt table test under ECG recording. Histogram of RR-interval series was
calculated, with 100 ms class, ranging from 600–1100 ms. In each class, mean
RR-intervals (MNN) and root-mean-squared difference (RMSNN) of consecutive normal
RR-intervals that suited a particular class were calculated. Average of all RMSNN
values in each class was analyzed as function of MNN, in the whole series
(RMSNNT), and in AC (RMSNNAC) and DC (RMSNNDC)
phases. Slopes of linear regression lines were compared between groups using
Student t-test. Correlation coefficients were tested before comparisons. RMSNN was
log-transformed. (α < 0.05). Results Correlation coefficient was significant in all regressions (p < 0.05). In the
control group, RMSNNT, RMSNNAC, and RMSNNDC
significantly increased linearly with MNN (p < 0.05). In ChD, only
RMSNNAC showed significant increase as a function of MNN, whereas
RMSNNT and RMSNNDC did not. Conclusion HRV increases in proportion with the RR-interval in healthy subjects. This
behavior is lost in ChD, particularly in the DC phase, indicating cardiac vagal
incompetence.
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Affiliation(s)
- Olivassé Nasario-Junior
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jurandir Nadal
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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