Heart Failure Secondary to Chagas Disease: an Emerging Problem in Non-endemic Areas

Traina, Mahmoud; Meymandi, Sheba; Bradfield, Jason S.

doi:10.1007/s11897-016-0305-9

Cited by 12 publications

(9 citation statements)

References 59 publications

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“…In Brazil, CD is responsible for 25% of all pacemaker implants [ 64 ]. In a study of Latin American-born patients with pacemakers in Los Angeles, 7.5% were found to have CD [ 65 ], suggesting CD as an underlying cause of cardiomyopathy may be severely underdiagnosed in the U.S. [ 66 •].…”

Section: Treatment Of Chronic Chagas Cardiomyopathymentioning

confidence: 99%

Treatment of Chagas Disease in the United States

Meymandi

Hernández

Park

et al. 2018

Curr Treat Options Infect Dis

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Purpose of ReviewChagas disease (CD) is endemic to much of Latin America, but also present in the United States (U.S.). Following a lengthy asymptomatic period, CD produces serious cardiac or gastrointestinal complications in 30–40% of people. Less than 1% of the estimated six million cases in the Americas, including 326,000–347,000 in the U.S., are diagnosed. Infected persons are typically unaware and the bulk of clinicians are unfamiliar with current treatment guidelines. This review provides U.S. and other clinicians with the latest knowledge of CD treatment.Recent FindingsChagas cardiomyopathy (CCM) causes severe fibrosis and autonomic damage in the myocardium. Eliminating the parasite through antitrypanosomal therapy with benznidazole, a nitroimidazole derivative or nifurtimox, a nitrofuran compound, potentially prevents heart failure and other sequelae of advanced CCM. Benznidazole, recently approved by the U.S. Food and Drug Administration (FDA) for children 2–12 years old, is the first-line therapy; optimal dosages are currently being studied. Antitrypanosomal therapy prevents congenital transmission; produces high cure rates for acute, congenital, and early chronic cases; and improves clinical outcomes in adult chronic indeterminate cases. However, this benefit was not observed in a large clinical trial that included patients with advanced CCM.SummaryTreatment with antitrypanosomal drugs can cure CD in acute, congenital, and early chronic cases and provides improved clinical outcomes for chronic indeterminate cases. This treatment should be offered as early as possible, before advanced CCM develops.

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Section: Treatment Of Chronic Chagas Cardiomyopathymentioning

confidence: 99%

Treatment of Chagas Disease in the United States

Meymandi

Hernández

Park

et al. 2018

Curr Treat Options Infect Dis

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“…This information is largely based on outdated individual studies, and reports vary substantially among the population based studies making the scientific interpretation challenging[ 8 , 20 , 25 – 28 ]. Furthermore, it is known that the prevalence of different types of ECG abnormalities such as intraventricular conduction abnormalities, atrioventricular block, and arrhythmias, is higher in subjects with CD as compared to non-CD subjects, 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[ 29 ]. Given the spread of CD, a need exists for an adequate, comprehensive assessment of CD in association with ECG abnormalities[ 6 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…CD, caused by the protozoan Trypanosoma cruzi , was previously estimated by the World Health Organization to affect some 16-18 million people throughout North, South, and Central America, 4 including over 300,000 people in the United States, based on a 2009 estimate. 5 Heart disease is the most frequent clinical manifestation of CD, affecting approximately 30% of infected individuals within 20 years after initial exposure. 6 Cardiac involvement is characterized by conduction system abnormalities, CM, VT, and SCD.…”

Section: Discussionmentioning

confidence: 99%