Chagas' heart disease: gender differences in myocardial damage assessed by cardiovascular magnetic resonance

Abstract

BackgroundSince a male-related higher cardiovascular morbidity and mortality in patients with Chagas’ heart disease has been reported, we aimed to investigate gender differences in myocardial damage assessed by cardiovascular magnetic resonance (CMR).Methods and resultsRetrospectively, 62 seropositive Chagas’ heart disease patients referred to CMR (1.5 T) and with low probability of having significant coronary artery disease were included in this analysis. Amongst both sexes, there was a strong negative correlation between LV ejection fraction and myocardial fibrosis (male r = 0.64, female r = 0.73, both P < 0.001), with males showing significantly greater myocardial fibrosis (P = 0.002) and lower LV ejection fraction (P < 0.001) than females. After adjustment for potential confounders, gender remained associated with myocardial dysfunction, and 53% of the effect was mediated by myocardial fibrosis (P for mediation = 0.004). Also, the transmural pattern was more prevalent among male patients (23.7 vs. 9.9%, P < 0.001) as well as the myocardial heterogeneity or gray zone (2.2 vs. 1.3 g, P = 0.003).ConclusionsWe observed gender-related differences in myocardial damage assessed by CMR in patients with Chagas’ heart disease. As myocardial fibrosis and myocardial dysfunction are associated to cardiovascular outcomes, our findings might help to understand the poorer prognosis observed in males in Chagas’ disease.

Transcriptomic and neurochemical analysis of the stellate ganglia in mice highlights sex differences

“…Recent clinical studies suggest that inflammation and immune cell infiltration of the stellate ganglia is a common feature in patients with severe arrhythmias 35 , 36 . Increased cardiac morbidity and mortality is observed in males with Chagas’ Disease 37 . Given that we saw more than twice as much Tcfl5 mRNA expression in the stellate ganglia of male mice, it would be interesting to know if the inflammatory state of the stellate ganglia is different between the sexes in Chagas’ Disease.…”

Sex Differences in Patients Hospitalized for Syncope: Experience in University Hospital of Middle-income Country and with a Predominance of Chagasic Etiology

“…Because the region where the research was developed to be an endemic area for Chagas disease, 46.5% of patients with structural heart disease had chagasic cardiomyopathy, predominantly in men. It has been reported a worse prognosis of this heart disease in men [23], evidencing greater ventricular remodeling and myocardial fibrosis [24]. In chronic Chagas cardiomyopathy, most probable causes of syncope, mainly recurrent, is VT which represents 43% of the causes of syncope [25].…”

Potential Role of Antioxidants as Adjunctive Therapy in Chagas Disease

“…In 82% of the studies, male animals were used without a clear reference to gender exclusion parameter. However, some researchers have reported an association between males, ROS levels, and increased severity of myocardial fibrosis associated with CD [49], thus justifying the use of males for a majority of published studies examining the antioxidants' efficacy in Chagas disease. Challenge infection was performed in all the studies by intraperitoneal inoculation of T. cruzi.…”