Electrophysiologic findings in long-term asymptomatic chagasic individuals

Pimenta, João; Miranda, Manoel; Pereira, Carlos Britto

doi:10.1016/0002-8703(83)90206-5

Cited by 31 publications

(16 citation statements)

References 18 publications

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“…3 Although we and others have demonstrated a favorable prognosis for seropositive adults with normal electrocardiograms,,13 22 echocardiography, electrophysiologic testing, and other sensitive techniques expose subtle abnormalities in many such persons. 23,24 These abnormalities are thought to represent residual foci of fibrosis or autonomic denervation from the acute stage of infection.3 The prognostic significance of these lesions has been debated, but our data suggest that they tend to remain subclinical. Clearly, the common practice of denying employment to all seropositive persons is unwarranted since the majority will not develop chronic heart disease.…”

Section: Discussionmentioning

confidence: 79%

Cardiac morbidity and mortality due to Chagas' disease: prospective electrocardiographic study of a Brazilian community.

Maguire¹,

Hoff²,

Sherlock³

et al. 1987

Circulation

216

160

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The evolution of Chagas' cardiomyopathy is poorly understood. We therefore examined the development of cardiac lesions in a rural Brazilian community for a period of 7 years. Initially, 42% of 1017 residents were seropositive for infection with Trypanosoma cruzi. Age-specific infection rates indicated that most had become infected before the age of 20 years. On follow-up, it appeared that those persons who developed cardiac lesions did so soon after infection, since the incidence of right bundle branch block and other ventricular conduction defects (VCDs) was also highest before age 20 years. The progressive nature of these lesions was demonstrated by frequent development of additional electrocardiographic abnormalities and high mortality among infected adults with VCDs. In contrast, mortality was low and approximately the same for seropositive and seronegative adults under 60 years who had normal electrocardiograms. Electrocardiography during the early asymptomatic stage of infection was able to distinguish persons with potentially lethal cardiac lesions from those with a benign prognosis.

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Section: Discussionmentioning

confidence: 79%

Cardiac morbidity and mortality due to Chagas' disease: prospective electrocardiographic study of a Brazilian community.

Maguire¹,

Hoff²,

Sherlock³

et al. 1987

Circulation

216

160

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“…The results of that study suggested that in seropositive individuals with right bundle branch block occurring in combination with anterior fascicular block or ventricular extrasystoles, the mortality rate was significantly higher than in seropositive persons with normal ECGs. Sinus node dysfunction was demonstrated in 8 of 44 asymptomatic seropositive individuals with normal chest X rays and ECGs (199 (40). Patients with both ECG abnormalities and heart failure were older, and their left ventricle was dilated and hypokinetic, with large apical aneurysms and thrombosis.…”

Section: Clinical Studiesmentioning

confidence: 99%

Chagas' disease

et al. 1992

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Chagas' disease, caused by Trypanosoma cruzi, is an important cause of morbidity in many countries in Latin America. The important modes of transmission are by the bite of the reduviid bug and blood transfusion. The organism exists in three morphological forms: trypomastigotes, amastigotes, and epimastigotes. The mechanism of transformation and differentiation is currently being explored, and signal transduction pathways of the parasites may be involved in this process. Parasite adherence to and invasion of host cells is a complex process involving complement, phospholipase, penetrin, neuraminidase, and hemolysin. Two clinical forms of the disease are recognized, acute and chronic. During the acute stage pathological damage is related to the presence of the parasite, whereas in the chronic stage few parasites are found. In recent years the roles of tumor necrosis factor, gamma interferon, and the interleukins in the pathogenesis of this infection have been reported. The common manifestations of chronic cardiomyopathy are arrhythmias and thromboembolic events. Autoimmune, neurogenic, and microvascular factors may be important in the pathogenesis of the cardiomyopathy. The gastrointestinal tract is another important target, and "mega syndromes" are common manifestations. The diagnosis and treatment of this infection are active areas of investigation. New serological and molecular biological techniques have improved the diagnosis of chronic infection. Exacerbations of T. cruzi infection have been reported for patients receiving immuno-suppressive therapy and for those with AIDS.

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“…Cardiac involvement was documented by chest radiography, two-dimensional echocardiography (ECHO) and one of the following imaging methods: technetium or gallium scanning, positron emission tomography and magnetic resonance imaging. After having agreed to participate in the study, the patients underwent the electrophysiological study (EPS) according to previously described techniques 13 . Followup was conducted with quarterly clinic visits, or as required.…”

Section: Methodsmentioning

confidence: 99%