Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis

Abstract

BackgroundChagas disease (CD) is a major public health concern in Latin America and a potentially serious emerging threat in non-endemic countries. Although the association between CD and cardiac abnormalities is widely reported, study design diversity, sample size and quality challenge the information, calling for its update and synthesis, which would be very useful and relevant for physicians in non-endemic countries where health care implications of CD are real and neglected. We performed to systematically review and meta-analyze population-based studies that compared prevalence of overall and specific ECG abnormalities between CD and non-CD participants in the general population.MethodsSix databases (EMBASE, Ovid Medline, Web of Science, Cochrane Central, Google Scholar and Lilacs) were searched systematically. Observational studies were included. Odds ratios (OR) were computed using random-effects model.ResultsForty-nine studies were selected, including 34,023(12,276 CD and 21,747 non-CD). Prevalence of overall ECG abnormalities was higher in participants with CD (40.1%; 95%CIs=39.2-41.0) compared to non-CD (24.1%; 95%CIs=23.5-24.7) (OR=2.78; 95%CIs=2.37-3.26). Among specific ECG abnormalities, prevalence of complete right bundle branch block (RBBB) (OR=4.60; 95%CIs=2.97-7.11), left anterior fascicular block (LAFB) (OR=1.60; 95%CIs=1.21-2.13), combination of complete RBBB/LAFB (OR=3.34; 95%CIs=1.76-6.35), first-degree atrioventricular block (A-V B) (OR=1.71; 95%CIs=1.25-2.33), atrial fibrillation (AF) or flutter (OR=2.11; 95%CIs=1.40-3.19) and ventricular extrasystoles (VE) (OR=1.62; 95%CIs=1.14-2.30) was higher in CD compared to non-CD participants.ConclusionsThis systematic review and meta-analysis provides an update and synthesis in this field. This research of observational studies indicates a significant excess in prevalence of ECG abnormalities (40.1%) related to T. cruzi infection in the general population from Chagas endemic regions, being the most common ventricular (RBBB and LAFB), and A-V B (first-degree) node conduction abnormalities as well as arrhythmias (AF or flutter and VE). Also, prevalence of ECG alterations in children was similar to that in adults and suggests earlier onset of cardiac disease.

WHF IASC Roadmap on Chagas Disease

“…Patients may suffer sudden cardiac death, thromboembolic phenomena, syncope, and congestive heart failure (CHF). Signs and symptoms of cardiac involvement primarily include electrical and mechanical alterations; sinus bradycardia, atrial and ventricular arrhythmias; atrioventricular and intraventricular conduction disorders, such as right bundle-branch block and/or left anterior fascicular block [35]; and ST-T changes. Cardiac imaging demonstrates regional wallmotion abnormalities, apical aneurysms, mural thrombi with embolic potential, and dilated cardiomyopathy with reduced LVEF [36] (Figure 5).…”

“…Cardiac mortality among CCC patients is mainly due to the high prevalence of life-threatening ventricular arrhythmias, manifesting as cardiac arrest and sudden death [23]. Additionally, the association of atrial fibrillation and apical aneurysms, along with a hypercoagulable state from T. cruzi infection provokes higher rates of embolic events compared to other heart failure etiologies [35,36].…”

Echocardiographic parameters, speckle tracking, and brain natriuretic peptide levels as indicators of progression of indeterminate stage to Chagas cardiomyopathy

“…Chagas Disease (ChD) represents an important cause of heart failure in endemic countries . Almost half of all seropositive Trypanosoma cruzi individuals will ultimately develop Chagas cardiomyopathy (CCM) within two or three decades after the initial infection . Moreover, ChD patients have an almost twofold higher annual mortality rate compared to noninfected patients .…”

Current knowledge of Chagas-related heart disease among pediatric cardiologists in the United States

“…The cardiac presentations of Chagas disease can be highly variable in pediatrics and limited data are available regarding the cardiac status of children in the U.S. with Chagas disease. Data from endemic countries shows cardiac presentations in neonates and infants with congenital Chagas disease, to adolescents showing pathologic and non-pathologic electrocardiographic changes, and even some adolescents with signs of cardiomyopathy [12][13][14][15][16][17][18][19][20]. Congenital Chagas disease is typically asymptomatic, but can present with heart failure, electrocardiogram (EKG) changes or myocarditis.…”