Electrocardiographic and Echocardiographic Abnormalities in Chagas Disease: Findings in Residents of Rural Bolivian Communities Hyperendemic for Chagas Disease

Abstract

Background Chagas disease is a neglected and preventable tropical disease that causes significant cardiac morbidity and mortality in Latin America. Our objective in this study was to describe cardiac findings among inhabitants of rural communities of the Bolivian Chaco. Methods The cardiac study drew participants from an epidemiologic study in 7 indigenous Guarani communities. All infected participants 10 years or older were asked to undergo a brief physical examination and 12-lead electrocardiogram. A subset had echocardiograms (ECGs). ECGs and echocardiograms were read by one or more cardiologists. Results Of 1137 residents 10 years or older, 753 (66.2%) had T. cruzi infection. Cardiac evaluations were performed for 398 infected participants 10 years or older. Fifty-five (13.8%) participants had one or more ECG abnormality suggestive of Chagas cardiomyopathy. The most frequent abnormalities were bundle branch blocks in 42 (11.3%), followed by rhythm disturbances or ventricular ectopy in 13 (3.3%) and atrioventricular blocks (AVB) in 10 (2.6%) participants. The prevalence of any abnormality rose from 1.1% among those 10-19 years old to 14.2%, 17.3% and 26.4% among those 20-39, 40-59 and older than 60 years, respectively. First degree AVB was seen most frequently in participants 60 years or older, but the 4 patients with 3rd degree AVB were all under 50 years old. Eighteen and two participants had a left ventricular ejection fraction of 40-54% and <40%, respectively. An increasing number of ECG abnormalities was associated with progressively larger left ventricular end-diastolic dimensions and lower left ventricular ejection fraction. Conclusions We found a high prevalence of ECG abnormalities and substantial evidence of Chagas cardiomyopathy. Programs to improve access to basic cardiac care (annual ECGs, antiarrhythmics, pacemakers) could have an immediate impact on morbidity and mortality in these highly endemic communities.

Trypanosoma cruzi infection in the human population of the Bolivian Chaco: four serosurveys over a 26-year period (1987-2013)

“…Cardiac disease could lead to progressive heart failure and sudden death, which are the main causes of death in patients with chronic Chagas heart disease [23]. In 2011, a high prevalence of ECG abnormalities and substantial evidence of Chagas cardiomyopathy (55/398, 13.8%), including bundle branch and/or atrioventricular blocks and rhythm disturbances associated with impaired left ventricular end-diastolic dimensions or ejection fraction, were found in a population-based survey among T. cruzi infected inhabitants living in a rural area of the Bolivian Chaco [24]. As expected, the prevalence of any abnormality rose proportionally with the age.…”

Cultural perception of triatomine bugs and Chagas disease in Bolivia: a cross-sectional field study

“…The Gran Chaco has the highest prevalence of CD in the world [50]. Despite the presence of insecticide spraying campaigns in the last 15 years in this region, T. cruzi prevalence remains extraordinarily high, with close to universal infection among adults over 30 years-old [15, 49, 59, 60]. In this region T. infestans , T. sordida and T. guasayana have been shown to infest houses [61, 62] and sylvatic populations of these tree species have been described [56, 57, 63–65].…”

Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC)

“…12 The prevalence of cardiac morbidity also increases with age. 13 An estimated 20% to 30% of T. cruzi-infected individuals eventually develop Chagas cardiomyopathy, but in endemic or previously endemic settings, a much higher percentage of the elderly may have cardiac signs. 3 Latin America has made substantial progress in decreasing T. cruzi transmission, largely through residual insecticide application to control domestic infestation.…”