Chagas Cardiomyopathy is Associated With Higher Incidence of Stroke: A Meta-analysis of Observational Studies

Cardoso, Rhanderson; Macedo, Francisco; Garcia, Melissa N.; García, Daniel; Benjo, Alexandre; Aguilar, David; Jneid, Hani; Bozkurt, Biykem

doi:10.1016/j.cardfail.2014.09.003

Cited by 42 publications

(33 citation statements)

References 30 publications

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“…Similarly, the markedly higher prevalence of prior stroke (in the absence of a substantially higher prevalence of atrial fibrillation) is consistent with concerns about high risk of thromboembolism in patients with Chagasic cardiomyopathy (and reflected in the higher use of anticoagulant therapy in these individuals). 30 We noted worse renal function in Chagasic patients, compared with the others, despite younger age and less diabetes mellitus and hypertension. Why this finding has not been previously reported and the reason for it is uncertain, the greater use of mineralocorticoid receptor antagonist in Chagasic patients and lower systolic blood pressure may have played a role.…”

Section: Discussionmentioning

confidence: 53%

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Shen

Ramires

Martínez

et al. 2017

Circ: Heart Failure

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Section: Discussionmentioning

confidence: 53%

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Shen

Ramires

Martínez

et al. 2017

Circ: Heart Failure

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“…The importance of the detection of these regional changes in contractile function is related to what has been shown in clinical studies of patients with areas of regional dyssynergy who have a more marked progression of global LV dysfunction on a medium‐term basis compared to patients with CCC without these changes . In addition, the presence of areas of LV dyssynergy is independently correlated with the incidence of LV mural thrombus and is significantly associated with the incidence of cardiovascular events during clinical follow‐up …”

Section: Discussionmentioning

confidence: 93%

Histopathological Correlates of Global and Segmental Left Ventricular Systolic Dysfunction in Experimental Chronic Chagas Cardiomyopathy

Oliveira

Romano

Carvalho

et al. 2016

JAHA

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BackgroundChronic Chagas cardiomyopathy in humans is characterized by segmental left ventricular wall motion abnormalities (WMA), mainly in the early stages of disease. This study aimed at investigating the detection of WMA and its correlation with the underlying histopathological changes in a chronic Chagas cardiomyopathy model in hamsters.Methods and ResultsFemale Syrian hamsters (n=34) infected with 3.5×104 or 105 blood trypomastigote Trypanosoma cruzi (Y strain) forms and an uninfected control group (n=7) were investigated. After 6 or 10 months after the infection, the animals were submitted to in vivo evaluation of global and segmental left ventricular systolic function by echocardiography, followed by euthanasia and histological analysis for quantitative assessment of fibrosis and inflammation with tissue sampling in locations coinciding with the left ventricular wall segmentation employed at the in vivo echocardiographic evaluation. Ten of the 34 infected animals (29%) showed reduced left ventricular ejection fraction (<73%). Left ventricular ejection fraction was more negatively correlated with the intensity of inflammation (r=−0.63; P<0.0001) than with the extent of fibrosis (r=−0.36; P=0.036). Among the 24 animals with preserved left ventricular ejection fraction (82.9±5.5%), 8 (33%) showed segmental WMA predominating in the apical, inferior, and posterolateral segments. The segments exhibiting WMA, in comparison to those with normal wall motion, showed a greater extent of fibrosis (9.3±5.7% and 7±6.3%, P<0.0001) and an even greater intensity of inflammation (218.0±111.6 and 124.5±84.8 nuclei/mm², P<0.0001).ConclusionsIsolated WMA with preserved global systolic left ventricular function is frequently found in Syrian hamsters with experimental chronic Chagas cardiomyopathy whose underlying histopathological features are mainly inflammatory.

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“…Stroke, systemic, and pulmonary embolism are common in CD, more so than in heart failure of other etiologies. The incidence of ischemic stroke in patients with CCC has been reported to be as high as 2.67 events/100 person-years [115]. Apical aneurysms, found in up to 50% of symptomatic CCC patients, and higher rates of atrial fibrillation in CCC contribute to this elevated thromboembolic risk.…”

Section: Clinical Management and Treatment Of Chronic Chagas Cardiomymentioning

confidence: 99%

WHF IASC Roadmap on Chagas Disease

et al. 2020

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Background: Chagas Disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, with some of the most serious manifestations affecting the cardiovascular system. It is a chronic, stigmatizing condition, closely associated with poverty and affecting close to 6 million people globally. Although historically the disease was limited to endemic areas of Latin America recent years have seen an increasing global spread. In addition to the morbidity and mortality associated with the disease, the social and economic burdens on individuals and society are substantial. Often called the 'silent killer', Chagas disease is characterized by a long, asymptomatic phase in affected indivi duals. A pproximately 30% then go on develop chronic Chagas cardiomyopathy and other serious cardiac complications such as stroke, rhythm disturbances and severe heart failure. Methods: In a collaboration of the World Hearth Federation (WHF) and the Inter-American S ociety of Cardiology (IASC) a writing group consisting of 20 diverse experts on Chagas disease (CD) was convened. The group provided up to date expert knowledge based on their area of expertise. An extensive review of the literature describing obstacles to diagnosis and treatment Echeverría et al: WHF IASC Roadmap on Chagas Disease Art. 26, page 2 of 31 of CD along with proposed solutions was conducted. A survey was sent to all WHF Members and, using snowball sampling to widen the consultation, to a variety of health care professionals working in the CD global health community. The results were analyzed, open comments were reviewed and consolidated, and the findings were incorporated into this document, thus ensuring a consensus representation. Results: The WHF IASC Roadmap on Chagas Disease offers a comprehensive summary of current knowledge on prevention, diagnosis and management of the disease. In providing an analysis of 'roadblocks' in access to comprehensive care for Chagas disease patients, the document serves as a framework from which strategies for implementation such as national plans can be formulated. Several dimensions are considered in the analysis: healthcare system capabilities, governance, financing, community awareness and advocacy. Conclusion: The WHF IASC Roadmap proposes strategies and evidence-based solutions for healthcare professionals, health authorities and governments to help overcome the barriers to comprehensive care for Chagas disease patients. This roadmap describes an ideal patient care pathway, and explores the roadblocks along the way, offering potential solutions based on available research and examples in practice. It represents a call to action to decision-makers and health care professionals to step up efforts to eradicate Chagas disease.

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Chagas Cardiomyopathy is Associated With Higher Incidence of Stroke: A Meta-analysis of Observational Studies

Cited by 42 publications

References 30 publications

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Histopathological Correlates of Global and Segmental Left Ventricular Systolic Dysfunction in Experimental Chronic Chagas Cardiomyopathy

WHF IASC Roadmap on Chagas Disease

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