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P1396 Three-dimensional cardiac mechanics for prediction of events in Chagas disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.829] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Chagas disease (CD) is an endemic infectious disease that still remains a great economic burden. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We assessed the hypothesis that 3D STE may predict clinical events in patients with CD.
Methods
This was a convenience sample. Patients with any systemic disease were excluded. Eight hundred and eight patients with CD were evaluated but only seventy-two were included. Clinical, electrocardiographic and comprehensive conventional and 3D echocardiography were performed. Patients were followed up for thirty-six up to sixty months. Clinical events were defined as hospitalization for heart failure, ventricular arrhythmias and cardiovascular death.
Results
Seventy-two patients were enrolled in three groups: Group 1 (G1), patients with left ventricular ejection fraction (LVEF) < 0.35 (N = 22); Group 2 (G2), LVEF between 0.35 and 0.55 (N = 22); Group 3 (G3), normal LVEF (N = 28). Gender distribution, mean age, anthropometric variables and risk factors were similar between the groups. 2D STE feasibility was 99.5, 99 and 100% in G1, G2 and G3. 3D Longitudinal strain feasibility was 93, 89 e 88% in G1, G2 and G3. Interobserver and intraobserver variabilities (Blant-Altman) for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS) are displayed in Table 1.
Hospitalization was related do indexed left atrium volume (p = 0,03) in G1. In G2, non-sustained ventricular tachycardia were related to 2D GLS values (p = 0,04); all clinical events were related do diastolic function (p = 0,30). In G1 and G2, hospitalization was related do indexed left atrium volume (p = 0,01); all clinical events were related do diastolic function (p = 0,004) and 3D LVEF (p = 0,02). 3D STE parameters were not related to clinical events.
Conclusions
In conclusion, 3D STE in patients with CD appears to be an accurate, reproducible and promising method but was not related to clinical events.
Table 1 INTEROBSERVER INTRAOBSERVER 2D GLS 0.96 ± 0.04 0.90 ± 0.08 3D GLS 0.92 ± 0.07 0.93 ± 0.10 3D GCS 0.88 ± 0.07 0.82 ± 0.15 3D AS 0.93 ± 0.05 0.90 ± 0.05 3D RS 0.85 ± 0.05 0.84 ± 0.11 Table 1. Interobserver and intraobserver variabilities for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS).
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P5681Effects of exercise training on cardiovascular autonomic modulation and skeletal muscle tissue in chagasic cardiopathy patients and preserved systolic function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Detection of Trypanosoma cruzi DNA in blood by PCR is associated with Chagas cardiomyopathy and disease severity. Eur J Heart Fail 2015; 17:416-23. [PMID: 25678239 DOI: 10.1002/ejhf.220] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/30/2014] [Accepted: 11/07/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. METHODS This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20 mL of blood. All testing was performed on coded samples. RESULTS Rates of PCR detection of T. cruzi DNA were significantly (P = 0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. CONCLUSION Trypanosoma cruzi PCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.
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Impairment of parasympathetic and sympathetic nervous systems in different forms of Chagas disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Association of angiotensin-converting enzyme activity and polymorphism with echocardiographic measures in familial and nonfamilial hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2009; 42:717-21. [PMID: 19390744 DOI: 10.1590/s0100-879x2009005000001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 03/24/2009] [Indexed: 11/22/2022]
Abstract
Angiotensin-converting enzyme (ACE) activity and polymorphism contribute significantly to the prognosis of patients with cardiomyopathy. The aim of this study was to determine the activity and type of ACE polymorphism in patients with familial and nonfamilial hypertrophic cardiomyopathy (HCM) and to correlate these with echocardiographic measurements (echo-Doppler). We studied 136 patients (76 males) with HCM (69 familial and 67 nonfamilial cases). Mean age was 41 +/- 17 years. DNA was extracted from blood samples for the polymerase chain reaction and the determination of plasma ACE levels. Left ventricular mass, interventricular septum, and wall thickness were measured. Mean left ventricular mass index, interventricular septum and wall thickness in familial and nonfamilial forms were 154 +/- 63 and 174 +/- 57 g/m(2) (P = 0.008), 19 +/- 5 and 21 +/- 5 mm (P = 0.02), and 10 +/- 2 and 12 +/- 3 mm (P = 0.0001), respectively. ACE genotype frequencies were DD = 35%, ID = 52%, and II = 13%. A positive association was observed between serum ACE activity and left ventricular mass index (P = 0.04). Logistic regression showed that ACE activity was twice as high in patients with familial HCM and left ventricular mass index >or=190 g/m(2) compared with the nonfamilial form (P = 0.02). No other correlation was observed between ACE polymorphisms and the degree of myocardial hypertrophy. In conclusion, ACE activity, but not ACE polymorphisms, was associated with the degree of myocardial hypertrophy in the patients with HCM.
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N-terminal prohormone brain natriuretic peptide (NT-proBNP) as a noninvasive marker for restrictive syndromes. Braz J Med Biol Res 2009; 41:664-7. [PMID: 18797698 DOI: 10.1590/s0100-879x2008000800004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 08/11/2008] [Indexed: 11/22/2022] Open
Abstract
Constrictive pericarditis (CP) and restrictive cardiomyopathy share many similarities in both their clinical and hemodynamic characteristics and N-terminal prohormone brain natriuretic peptide (NT-proBNP) is a sensitive marker of cardiac diastolic dysfunction. The objectives of the present study were to determine whether serum NT-proBNP was high in patients with endomyocardial fibrosis (EMF) and CP, and to investigate how this relates to diastolic dysfunction. Thirty-three patients were divided into two groups: CP (16 patients) and EMF (17 patients). The control group consisted of 30 healthy individuals. Patients were evaluated by bidimensional echocardiography, with restriction syndrome evaluated by pulsed Doppler of the mitral flow and serum NT-proBNP measured by immunoassay and detected by electrochemiluminescence. Spearman correlation coefficient was used to analyze the association between log NT-proBNP and echocardiographic parameters. Log NT-proBNP was significantly higher (P < 0.05) in CP patients (log mean: 2.67 pg/mL; 95%CI: 2.43-2.92 log pg/mL) and in EMF patients (log mean: 2.91 pg/mL; 95%CI: 2.70-3.12 log pg/mL) compared with the control group (log mean: 1.45; 95%CI: 1.32-1.60 log pg/mL). There were no statistical differences between EMF and CP patients (P = 0.689) in terms of NT-proBNP. The NT-proBNP log tended to correlate with peak velocity of the E wave (r = 0.439; P = 0.060, but not with A wave (r = -0.399; P = 0.112). Serum NT-proBNP concentration can be used as a marker to detect the presence of diastolic dysfunction in patients with restrictive syndrome; however, serum NT-proBNP levels cannot be used to differentiate restrictive cardiomyopathy from CP.
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Leptin levels in different forms of Chagas' disease. Braz J Med Biol Res 2007; 40:1631-6. [PMID: 17713658 DOI: 10.1590/s0100-879x2006005000152] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 07/02/2007] [Indexed: 11/21/2022] Open
Abstract
Leptin is produced primarily by adipocytes. Although originally associated with the central regulation of satiety and energy metabolism, increasing evidence indicates that leptin may be an important mediator in cardiovascular pathophysiology. The aim of the present study was to investigate plasma leptin levels in patient with Chagas' heart disease and their relation to different forms of the disease. We studied 52 chagasic patients and 30 controls matched for age and body mass index. All subjects underwent anthropometric, leptin and N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements and were evaluated by echocardiography, 12-lead electrocardiogram (ECG), and chest X-ray. All patients had fasting blood samples taken between 8:00 and 9:00 am. Chagasic patients were divided into 3 groups: group I (indeterminate form, IF group) consisted of 24 subjects with 2 positive serologic reactions for Chagas' disease and no cardiac involvement as evaluated by chest X-rays, ECG and two-dimensional echocardiography; group II (showing ECG abnormalities and normal left ventricular systolic function, ECG group) consisted of 14 patients; group III consisted of 14 patients with congestive heart failure (CHF group) and left ventricular dysfunction. Serum leptin levels were significantly lower (P < 0.001) in the CHF group (1.4 +/- 0.8 ng/mL) when compared to the IF group (5.3 +/- 5.3 ng/mL), ECG group (9.7 +/- 10.7 ng/mL), and control group (8.1 +/- 7.8 ng/mL). NT-proBNP levels were significantly higher (P < 0.001) in the CHF group (831.8 +/- 800.1 pg/mL) when compared to the IF group (53.2 +/- 33.3 pg/mL), ECG group (83.3 +/- 57.4 pg/mL), and control group (32 +/- 22.7 pg/mL). Patients with Chagas' disease and an advanced stage of CHF have high levels of NT-ProBNP andlow plasma levels of leptin. One or more leptin-suppressing mechanisms may operate in chagasic patients.
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Abstract
OBJECTIVE To assess, in a prospective way, the experience with video-assisted pericardioscopy obtained in patients with pericardial effusion of unclear etiology in the preoperative period. METHODS From January 1998 to June 2000, 20 patients were operated upon with the aid of video-assisted pericardioscopy. On echocardiography, 17 of these patients had significant pericardial effusion, and 3 had moderate pericardial effusion. Video-assisted pericardioscopy was performed through a small incision of the Marfan type. RESULTS The diagnosis of pericardial effusion was established as follows: idiopathic in 9 (45%) patients, neoplastic in 4 (20%), resulting from hypothyroidism in 3 (15%), tuberculous in 2 (10%), due to cholesterol in 1 (5%), and chylopericardial in 1 (5%). The biopsy was positive in 30% of the patients, and the etiology could not be defined in 45% of the patients. CONCLUSION Video-assisted pericardioscopy proved to be a method with low morbidity and a high index of diagnostic positivity. A high percentage of pericardial effusions are caused by viral infections, which are not diagnosed through current methods, being, therefore, classified as idiopathic.
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Chagas' heart disease: evolutive evaluation of electrocardiographic and echocardiographic parameters in patients with the indeterminate form. Arq Bras Cardiol 2001; 77:59-62. [PMID: 11500748 DOI: 10.1590/s0066-782x2001000700006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify and associate potential electrocardiographic and echocardiographic changes in patients with the indeterminate form of Chagas' disease during long-term follow-up. METHODS One hundred sixty patients underwent standard electrocardiography and two-dimensional guided M-mode echocardiography for left ventricular ejection fraction determination. Patients were followed up for 98.6+/-30.4 months, undergoing repeat electrocardiographic studies at 6-month intervals and echocardiographic studies at 12-month intervals. RESULTS Based on the electrocardiographic findings, the patients were divided into group I, 125 patients (78.6%) with normal electrocardiograms throughout follow-up, and group II, 34 patients (21.3%) who developed electrocardiographic changes. Group II was further divided into group IIA (9 patients, 5.6%) with permanent electrocardiographic changes, group IIB (14 patients, 8.8%) with transitory electrocardiographic changes, and group IIC (11 patients, 6.9%) with changes appearing only on the final electrocardiogram. Left ventricular ejection fractions remained normal in the entire population studied and did not differ among groups. CONCLUSION The indeterminate form of Chagas' disease clearly represents a benign condition with a favorable long-term prognosis. Although some patients develop electrocardiographic changes, left ventricular systolic function is well preserved.
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Abstract
During a diagnostic investigation in a 40-year-old male with pericardial effusion associated with hypothyroidism, cholesterol pericarditis was detected. We report a brief review on the etiopathogeny, clinical findings, and therapeutical possibilities of this entity.
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Abstract
OBJECTIVE To analyze clinical and histologic findings of 50 patients with primary neoplasms of the heart in a tertiary referral center. METHODS From 1980 to 1998, we retrospectively analyzed 50 patients, 32 of whom were females, whose ages ranged from 9 to 73 years (mean age = 44.16+/-18 years). RESULTS Most tumors were located in the left side of the heart (72%), myxoma being the most common (84%) histologic type. The other histologic types found were as follows: fibroma (4%), lipoma (2%), rhabdomyosarcoma (2%), hemangioma (2%), sarcoma (2%), angiosarcoma (2%), and lymphoma (2%). Diagnosis was established by echocardiography in 94% of the cases. Clinical findings were as follows: dyspnea (36%), weight loss (20%), palpitations (18%), chest pain (16%), fever (8%), and arthralgia (6%). All patients with thromboembolic phenomena (10%) had left atrial myxoma. Approximately 20% of the patients were asymptomatic at the initial clinical assessment. CONCLUSION Primary cardiac tumors are a rare entity with diverse clinical and histologic findings, requiring, therefore, a high level of clinical suspicion.
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Maximal functional capacity in patients with Chagas' cardiomyopathy without congestive heart failure. J Card Fail 2000; 6:220-4. [PMID: 10997748 DOI: 10.1054/jcaf.2000.8828] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chagas' disease is a known dilated form of cardiomyopathy. However, a great number of patients, although showing electrocardiographic (ECG) well-recognized changes, maintain normal ventricular chamber dimensions and are asymptomatic. The aim of the present study was to objectively characterize functional capacity in asymptomatic patients with Chagas' disease and normal left ventricular function. METHODS AND RESULTS Eighteen asymptomatic male patients with Chagas' disease, aged 33+/-6 years, were selected for the study. All showed ECG changes typical of the disease, as well as left ventricular fractional shortening (LVFS) greater than 0.30 on M-mode 2-dimensionally guided echocardiography. Twenty sedentary normal male patients, aged 29+/-6 years, served as controls. Both groups were submitted to ergoespirometry testing for assessment of exercise functional capacity. Patients with Chagas' disease, when compared with controls, showed lower (P < .001) maximal O2 consumption (VO2max, 24.3+/-4.2 v 37.0+/-5.4 mL x kg(-1) x min(-1) respectively); O2 pulse rate (PO2max, 10.5+/-1.4 v 15.1+/-2.5 mL/beat, respectively); maximal ventilation (VEmax, 50.1+/-13.5 v 113.0+/-17.6 L x min(-1), respectively); anaerobic threshold of maximal O2 consumption (VO2-AT, 15.8+/-3.6 v 24.6+/-4.7 mL x kg(-1) x min(-1), respectively); and maximal heart rate (HRmax, 154+/-21 v 186+/-7 beat x min(-1), respectively). CONCLUSIONS Asymptomatic patients with Chagas' disease, although presenting normal left ventricular systolic function at rest, display a substantial impairment of exercise functional capacity.
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Abstract
Cardiac performance is negatively associated with interstitial collagen in Chagas' cardiomyopathy. The magnitude of dysfunction is related to the degree of collagen, and this association seems to exhibit a threshold above it if definite cardiac deterioration occurs.
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Abstract
PURPOSE To characterize patients with neoplastic pericardial disease diagnosed by clinical presentation, complementary test findings, and the histological type of tumor. METHODS Twenty-six patients with neoplastic pericardial disease were retrospectively analyzed. RESULTS Clinical manifestations and abnormalities in chest roentgenograms and electrocardiograms were frequent, but were not specific. Most patients underwent surgery. There was a high positivity of the pericardial biopsy when associated with the cytological analysis of the pericardial liquid used to determine the histological type of the tumor, particularly when the procedure was performed with the aid of pericardioscopy. CONCLUSION The correct diagnosis of neoplastic pericardial disease involves suspicious but nonspecific findings during clinical examination and in screen tests. The suspicious findings must be confirmed through more invasive diagnostic approaches, in particular pericardioscopy with biopsy and cytological study.
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Abstract
We studied the incidence of AF in patients with endomyocardial fibrosis (EMF) and its influence on prognosis and associated clinical events. One hundred and sixty consecutive patients with EMF were followed for a mean period of 4 years. Their mean age was 39.7 years. There were 114 women. During follow-up there were 56 deaths. Eighty-eight patients (55%) were submitted to surgical intervention. AF was observed in 58 cases (36.2%). The presence of AF was associated with a greater prevalence of dyspnea, peripheral edema, hepatomegaly, lower left ventricular ejection fraction, lower right ventricular systolic pressure (37.8 vs 45.6 mmHg, P=0.0392), and greater incidence of tricuspid regurgitation (86.0 vs 63.2%, P=0.004). AF was more frequent among patients in whom the disease involved the right ventricle, particularly those with intense fibrosis. Overall, patients with AF had a higher mortality rate than those who did not have AF (43.1 vs 30.3%, P=0.0195), but among those submitted to surgery, AF did not have an impact on survival. In conclusion, AF is frequent among patients with EMF. It is more prevalent among patients with right ventricular involvement and its presence is associated with a greater incidence of heart failure. AF is associated with worse prognosis, but surgery potentially reverses this bad evolution.
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Abstract
We describe a case of a patient with idiopathic pericardial effusion that during investigation proved to be a chylopericardium. Lymphangiography showed the chylopericardium to be due to partial aplasia of the thoracic duct. A brief review the etiology, clinical feature, diagnostic procedures and therapeutic possibilities of chylopericardium is presented.
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[Cardiovascular diseases observed during follow-up of a group of patients with undetermined form of Chagas' disease]. Arq Bras Cardiol 1998; 71:21-4. [PMID: 9755530 DOI: 10.1590/s0066-782x1998000700005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the cardiovascular outcome in patients with the undetermined form of Chagas' disease and whether or not it is related to the infectious disease in the long-term. METHODS One hundred and sixty patients were prospectively followed-up at three month intervals for up to 177 months. RESULTS Twenty and three (14.4%) patients developed hypertension complicated by ischemic stroke in two (1.2%) and symptomatic heart failure in one (0.6%). Cardiac arrhythmias occurred in four (2.4%) patients corresponding to isolated ventricular ectopic beats in two (1.2%), isolated supraventricular ectopic beats in one (0.6%) and an isolated episode of acute atrial fibrillation in another (0.6%). Two (1.2%) patients developed symptoms of coronary artery disease, one of them had one episode of acute chest pain diagnosed as myocardial infarction and the other had chronic chest pain diagnosed as angina. CONCLUSION Hypertension is the most common cardiovascular disease occurring in the long-term follow-up of patients with the undetermined form of Chagas' disease. Cardiac rhythm disturbances and coronary artery disease were not more frequent than those generally found in a healthy population. These data confirm a favorable long-term prognosis in patients with the undetermined form of Chagas' disease.
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Abstract
PURPOSE To determine the value of pericardial biopsy as a complementary exam in the etiology of pericardial effusion. METHODS We analyzed retrospectively (from 1990 to 1997) 38 patients with pericardial effusion. The age ranged between 3 months and 79 years (mean 41.15 +/- 21.78 years). Pericardial biopsy was performed in all cases through a subxiphoid incision. RESULTS In 4 patients (10.5%) the biopsy was able to define etiology, 2 had tuberculosis and 2 neoplasias (1 undetermined adenocarcinoma, 1 mesotelioma). In 34 patients the biopsy showed non-specific chronic pericarditis. CONCLUSION Pericardial biopsy was not an effective method to determine the etiological diagnosis in pericardial effusion patients. We believe that we have to individualize the indication of pericardial biopsy especially if tuberculosis or neoplasia are suspected.
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[Therapeutics for the chronic form of Chagas' disease. Is the etiological treatment effective?]. Arq Bras Cardiol 1998; 70:59-61. [PMID: 9629690 DOI: 10.1590/s0066-782x1998000100012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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[Maximal functional capacity and diastolic function in patients with cardiomyopathy due to Chagas' disease without congestive heart failure]. Arq Bras Cardiol 1997; 69:237-41. [PMID: 9595715 DOI: 10.1590/s0066-782x1997001000003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To identify early cardiac dysfunctions in asymptomatic patients with Chagas' cardiomyopathy. METHODS We studied 38 male individuals: control group consisting of 20 sedentary normal individuals and Chagas' group, of 18 asymptomatic patients with Chagas' disease, with suggestive electrocardiographic alterations and normal fractional shortening (FS) on echocardiogram. Both groups were submitted to evaluation of the maximal functional capacity, with measurements of maximal O2 consumption (VO2max), O2-pulse rate (PO2max), maximal ventilation (VEmax), maximal heart rate (HRmax), and anaerobic threshold of the VO2max (VO2-AT). Left ventricular diastolic function was evaluated by conventional echocardiography (E wave, A wave and E/A ratio). RESULTS No significant differences occurred between the two groups with regard to FS (p = 0.212) and age means (p = 0.060). The 2 groups were significantly different (p < 0.001) regarding the parameters VO2max, PO2max, VEmax, HRmax and VO2-AT, E wave and E/A ratio. There was no difference (p = 0.520) in A wave. CONCLUSION Impaired ventricular function may account for the above mentioned differences, a consequence of both systolic and diastolic dysfunctions.
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[Radiological findings in endomyocardial fibrosis]. Arq Bras Cardiol 1997; 68:269-72. [PMID: 9497508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine through conventional radiology the type of ventricular involvement in endomyocardial fibrosis (EMF). METHODS We analyzed 56 cases with EMF confirmed by angiocardiography and 9 by postmortem study, aged between 16 and 56 years (mean 32); there were 42 females. Only one radiologist analyzed X-rays without any knowledge of the cineangiography findings. RESULTS The right side of the heart was primarily involved in 9 patients and the cardiac silhouette was characteristically globular and had oligemic pulmonary fields (66.66%). The cardiothoracic ratio was 0.62 +/- 0.11. Out of 9 patients, 8 were female. The left side of the heart was established as being primarily involved in 11 cases and simulated rheumatic mitral disease. The cardiothoracic ratio was 0.51 +/- 0.09 and there were increased pulmonary fields in 63.6%. The biventricular disease occurred in 36 cases. There were radiologic findings of right and left side. The cardiothoracic ratio was 0.63 +/- 0.06 and there was oligemic pulmonary fields in 38.8%, increased pulmonary fields in 33.3% and was normal in 27.7%. There were 4:1 females. CONCLUSION The radiological study is fundamental in the initial diagnosis of EMF. The type of involvement could be done in 66.07% of all cases by chest X-ray.
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[The indeterminate form of Chagas's disease. Myths vs facts]. Arq Bras Cardiol 1997; 68:147-8. [PMID: 9435350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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[Normal maximal functional capacity in patients with congestive heart failure due to Chagas' cardiomyopathy]. Arq Bras Cardiol 1996; 67:1-4. [PMID: 9035458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare patients with heart failure due to Chagas' cardiomyopathy and maximal oxygen consumption greater than 20mL/kg-1/min-1 to normal individuals. METHODS We studied 104 male patients with heart failure due to Chagas' cardiomyopathy, functional classe II-IV, age 18 to 65 years (40.3 +/- 9.0), and 23 normal sedentary male individuals (GI) age 17 to 51 years (35 +/- 8.7). Maximal oxygen consumption (VO2max) was obtained using a Beckman metabolic measurement cart, and left ventricular ejection fraction (EF) by conventional transthoracic echocardiography. Comparisons between means were made with t-test. RESULTS Thirty seven patients (35.6%) presented VO2max above 20mL/kg-1/min-1 (G2), with values ranging from 20.5 to 30 (24.5 +/- 2.9) and EF between 19 and 63% (42 +/- 11.7). GI had VO2max between 21 and 42mL/kg-1/min-1 (33.3 +/- 5.6) and EF between 70 and 82% (75.1 +/- 3.2). Ages were not significantly different for the two groups (p = 0.1136). VO2max and EF were lower in G2, and this was statistically significant (p < 0.0001). CONCLUSION These results indicate that patients with congestive heart failure due to Chagas disease may show values of VO2max, greater than 20mL/kg-1/min-1 which does not mean that they have normal maximal functional capacity.
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[Relationship between ventricular arrhythmia and cardiac function in Chagas disease]. Arq Bras Cardiol 1995; 64:533-5. [PMID: 8561672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE It is well established the association between heart failure and arrhythmias in different cardiopathies. There are no studies in Chagas' myocardiopathy that analyze the relation between arrhythmias and left ventricular function. METHODS We studied 629 patients with Chagas' disease, divided in 3 groups, according to ejection fraction obtained through echocardiographic study (normal, between 0.64 and 0.45, and below 0.44). RESULTS At conventional ECG, the presence of ventricular arrhythmias was respectively in the 3 groups: 15%, 36% and 64%, showing higher incidence when left ventricular function was getting worse. CONCLUSION Ventricular arrhythmias in Chagas' disease are frequent in patients with normal ejection fraction, and become more intense as ventricular dysfunction progresses.
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Abstract
The undetermined form of Chagas' disease is diagnosed in asymptomatic subjects with a positive blood test for Chagas' disease, normal resting electrocardiogram, chest X-ray, barium esophageal and large bowel radiological studies. Other investigation methods are not recommended for identification of other organs damage lesions in this phase of the disease. When other methods of investigation were employed, cardiac and digestive abnormalities of small magnitude were detected without prognostic implications. These findings do not warrant frequent examinations of patients with undetermined form of the disease except for the electrocardiogram or if the patients report other clinical manifestations. The benign course of the disease does not preclude ability to work and the subjects should be considered apt for work in any profession.
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[Male sex. Prognostic factor in Chagas' disease]. Arq Bras Cardiol 1993; 60:225-7. [PMID: 8311729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To verify if the ventricular function and the incidence of arrhythmias in patients of both sexes could be predominant in male patients with Chagas' disease. METHODS Six hundred and thirty one patients were studied, 329 female and 302 male, with age of 10 to 64 years old (mean 40). All patients were submitted to M mode echocardiographic study to analyse the ejection fraction (EF). To verify the importance of the ventricular dysfunction in male and female patients, they were divided according to the EF in three groups: A) normal EF, B) EF between 0.64 and 0.45 and C) EF less than 0.44. The incidence of ventricular tachycardia was analyzed at the stress test or 24h Holter studies. RESULTS The number of patients with depressed EF was more frequent on male patients (p < 0.0001). The incidence of ventricular tachycardia was similar in both sexes, however it was more frequent in patients with ventricular dysfunction. CONCLUSION Our results show that there are greater myocardial dysfunction on male patients, what could explain the worse prognosis observed on patients of this sex.
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[Indeterminate form of Chagas' disease. A polymorphic disease]. Arq Bras Cardiol 1990; 55:347-53. [PMID: 2128863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the association between the indeterminate form of Chagas' disease and abnormalities in non-invasive cardiovascular propedeutics. PATIENTS AND METHODS Twenty-two patients in the indeterminate form of Chagas' disease, 17 female, with ages between 25 and 50 years were submitted to studies of: vectorcardiography, echocardiography, stress test, dynamic electrocardiography and scintigraphic studies (scintigraphic ventriculography and cardiac mapping with pyrophosphate of technetium), in a period of two months after first consultation. RESULTS The analysis shows the percentual of altered exams: vectorcardiogram--68.2% (conduction disturbance--22.7%); echocardiogram--15.8% (apical hypokinesia); cardiac mapping 61.8%; scintigraphic ventriculography--68.2%; stress test--72.2% (reduced delta PS--50%, ventricular arrhythmia--50%); and dynamic electrocardiographic--50% (ventricular arrhythmias). We could observe also that the great majority of the patients has more than three exams altered (63.6%). The study of relation between methods, shows only association between reduced delta PS and ventricular arrhythmia, with concordant results in 72.7%. CONCLUSION Indeterminate form of Chagas' disease appears to be a really chronic form, may be of attenuate aggressive potential, with indeterminate evolution and with polymorphic clinical exteriorization seeing only through invasive and non invasive propedeutic techniques.
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[The biopsy in the diagnosis of pericardial involvement by malignant tumor]. Arq Bras Cardiol 1989; 53:157-9. [PMID: 2629671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We performed pericardial biopsy by subxiphoid approach in twelve patients (eight men, four women) with cardiac tamponade or pericardial effusion without low cardiac output, in order to search for the underlying disease. Five patients (41%) had pericardial biopsy with malignant neoplastic invasion. In seven patients (59%) the biopsy was nonspecific; in these patients, the diagnosis was made by another methods. We concluded that the pericardial biopsy is a safe method, with high especificity but low sensibility in the diagnosis of malignant pericardial invasion.
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[Cardiac thrombosis and embolism in patients having died of chronic Chagas cardiopathy]. Arq Bras Cardiol 1989; 52:189-92. [PMID: 2604564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The authors studied the files of 111 patients (mean age 47.5 years) with chronic Chagas' disease and severe heart failure who had died between 1978 and 1984; they were 72 men and 39 women. Eighty-one patients (73%) had cardiac thrombosis, 65 times (53%) in right chambers and 56 times (46%) in left ones. Sixty-seven patients (60%) had thromboembolic episodes, 41 (65%) to the lungs, 23 (38%) to other organs (target organs: the kidneys in 21 cases, spleen in four, brain in two, abdominal aorta in one, mesenteric artery in one and iliac artery in one). Right chamber thrombosis occurred 65 times, 35 (53%) with pulmonary thromboembolism. Left chamber thrombosis occurred 56 times, 24 (42%) with systemic thromboembolism. A total of 41 patients had pulmonary thromboembolism, only six (14%) without right chamber thrombosis; of 26 patients with systemic thromboembolism, only two (7%) did not have left chamber thrombosis. The authors concluded that the incidence of thrombosis and thromboembolism was high in the group studied, and that there was a relationship between chamber thrombosis and systemic or pulmonary thromboembolism.
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[The value of the electrocardiogram in evaluating myocardial function in patients with Chagas' disease]. Arq Bras Cardiol 1989; 52:69-73. [PMID: 2512896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The authors studied the electrocardiogram of 1004 patients with Chagas' disease. The fit of this observation was the correlation between the electrocardiographic alterations with the cardiac compromise, which was analysed clinically, by thorax X-ray, echocardiogram and stress test. The results show that increased cardiothoracic index, and decreased ejection fraction, decreased difference between systolic blood pressure before the exercise and at the final of the stress test at maximal weight were associated with greater incidence of ventricular premature beat, intraventricular heart block, inactive area, ST-T alteration. chi 2 test shows that these association was significative. The presence of premature ventricular beats and inactive area on the electrocardiographic study seems to determine worse prognosis to the patients since these alterations were more frequent on the patients that died due to Chagas' disease.
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31
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[Temporal variation of titers of serologic reactions in the chronic phase of Chagas disease and its possible clinical correlation]. Arq Bras Cardiol 1988; 51:143-6. [PMID: 3150802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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32
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[The clinical picture of endomyocardial fibrosis. Correlation with the intensity of fibrosis]. Arq Bras Cardiol 1988; 50:401-5. [PMID: 3248061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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33
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[The electrocardiogram in patients with active lymphocytic myocarditis]. Arq Bras Cardiol 1988; 50:43-6. [PMID: 3219096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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34
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[Surgical treatment of chronic constrictive pericarditis]. Arq Bras Cardiol 1988; 50:15-8. [PMID: 3219094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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35
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[Clinical course of patients with suspicion of myocarditis. Comparison of groups with and without suggestive biopsy]. Arq Bras Cardiol 1987; 49:15-7. [PMID: 3450254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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36
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[Incidence of congenital transmission of Chagas' disease]. Arq Bras Cardiol 1987; 49:47-9. [PMID: 3130828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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37
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[Peripartum cardiomyopathy]. Arq Bras Cardiol 1987; 48:375-7. [PMID: 3446136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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38
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[Endomyocardial biopsy in patients with peripartum cardiomyopathy]. Arq Bras Cardiol 1986; 47:403-5. [PMID: 3662882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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39
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[Active lymphocyte infiltrate in idiopathic dilated cardiomyopathy]. Arq Bras Cardiol 1986; 47:243-6. [PMID: 3593025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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40
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[Angiosarcoma of the heart. A case report]. Arq Bras Cardiol 1986; 47:211-5. [PMID: 3593021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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41
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[Arrhythmias and the indeterminate form of Chagas' disease]. Arq Bras Cardiol 1986; 47:197-9. [PMID: 3109354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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42
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[Tuberculous pericarditis. Diagnostic difficulties and value of pericardial biopsy]. Arq Bras Cardiol 1986; 47:27-30. [PMID: 3579640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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43
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[The electrocardiogram in patients with positive serological reactions for Chagas' disease. Study of 600 cases]. Arq Bras Cardiol 1985; 44:333-7. [PMID: 4091730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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44
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[The vectorcardiogram in the undetermined form of Chagas' disease]. Arq Bras Cardiol 1985; 44:83-5. [PMID: 4084089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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45
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Abstract
Right ventricular endomyocardial biopsy was carried out in thirty three patients with undetermined form of Chagas' disease. Fragments obtained by this method were analysed under light microscopy with hematoxilin-eosin, and Masson trichromic stains. Thirteen (39.4%) patients showed normal myocardial fragments and twenty patients (60.6%) had them altered. Alterations included fiber degeneration, volume changes, interstitial edema, inflammatory infiltrates and fibrosis. These data permit to conclude that only part of patients with this form of Chagas' disease have an incipient myocardial attack and that the alterations found in the fragments obtained are mild. The remaining patients would be either individuals with chagasic infection without cardiac disease or have spontaneous healing. This should be considered in the future treatment of the disease.
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46
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[Chronic constrictive pericarditis. Importance of non-invasive complementary tests]. Arq Bras Cardiol 1984; 43:87-91. [PMID: 6532390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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47
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[Correlation between electro- and vectorcardiographic changes and left ventricular performance in chronic Chagas' cardiomyopathy]. Arq Bras Cardiol 1983; 41:189-93. [PMID: 6675609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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48
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[Value of the cardiothoracic index on the evaluation of myocardial involvement. Correlation with echocardiographic evaluation]. REVISTA DO HOSPITAL DAS CLINICAS 1983; 38:40-5. [PMID: 6227074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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49
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[Electric cardioversion in a patient with Chagas' disease with a cardiac pacemaker and atrial flutter resistant to drug therapy. Report of a case]. Arq Bras Cardiol 1982; 39:405-8. [PMID: 7186396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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50
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[Variant of the classic standard of right branch block associated with antero-superior division of the left branch block. Prognosis in Chagas' disease]. Arq Bras Cardiol 1982; 38:375-9. [PMID: 7168669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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