Ischemic stroke classification and risk of embolism in patients with Chagas disease

Montanaro, Vinícius Viana Abreu; Silva, Creuza Maria da; Santos, Carla Verônica de Viana; Lima, Maria Inacia Ruas; Negrão, Edson Marcio; Freitas, Gabriel R. de

doi:10.1007/s00415-016-8275-0

Cited by 17 publications

(23 citation statements)

References 19 publications

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“…This score was found to be superior to the classical TOAST criteria in these patients [17]. Disagreements between investigators were resolved through discussion and consensus.…”

Section: Methodsmentioning

confidence: 99%

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

et al. 2018

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Background: Chagas disease is related to ischemic stroke (IS), although few epidemiological studies have evaluated the associated mortality and recurrence. Our objective is to determine factors associated with mortality and recurrence of IS in patients with IS and Chagas disease. Methods: We retrospectively studied data obtained from electronic medical records of patients admitted at SARAH Hospitals across Brazil between 2009 and 2013. Using Cox regression analysis for mortality and logistic regression for recurrence, we assessed primary population characteristics and statistical associations between risk factors and outcomes. Results: We analyzed 279 patients who were followed up until 2016. The mean age at stroke onset was 61 with a 10% frequency of death. Multivariate analysis assessing mortality demonstrated that the associated factors were age at stroke (hazard ratio [HR] 1.04), initial modified Rankin Scale (mRS; HR 20.91), bladder dysfunction (HR 2.51), diabetes mellitus (DM; HR 3.64), and alcoholism (HR 3.37). Multivariate analysis assessing recurrence demonstrated that the associated factors were age at ictus (OR 0.96), cognitive deficit (OR 0.44), initial mRS (OR 1.84), cardioembolic etiology (OR 2.47), and female sex (OR 2.73). Conclusions: Cardiac conditions did not correlate with mortality or recurrence. Age was a protective factor against recurrence, probably due to cumulative risk of IS over time, while initial mRS was associated with both outcomes. Treating diseases such as DM and bladder dysfunction, and early treatment to reduce the initial mRS could potentially prevent both outcomes; also, establishing a correct etiological diagnosis is important.

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“…This score was found to be superior to the classical TOAST criteria in these patients [17]. Disagreements between investigators were resolved through discussion and consensus.…”

Section: Methodsmentioning

confidence: 99%

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

et al. 2018

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“…Nonetheless, blood flow stasis secondary to an abnormal ventricular function and atrial arrhythmias may also play a significant role. Other established risk factors are left atrial enlargement, older age, and concomitant classical cardiovascular risk factors such as hypertension and dyslipidemia that promote a proinflammatory and prothrombotic state endothelial dysfunction [ 92 , 93 , 94 , 95 , 96 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

et al. 2021

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Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community’s apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host–parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease’s clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy’s (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.

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“…A total of 7.3% of the cohort was in a high-risk group (4-5 points) and 45% of them had the CIS diagnostic. This score was included in the Brazilian consensus and Latin American guideline for treatment of CD as an important strategy for detection of patients at increased risk of CIS [3,8,14].…”

Section: The Ipec-fiocruz Stroke Score For Patients With Chagas Diseasementioning

confidence: 99%

“…Recently, Montanaro et al [14] conducted a retrospective study that aimed to evaluate the performance of the IPEC-FIOCRUZ score in identifying patients at high risk of CIS. The authors included patients admitted to the SARAH Hospital of Rehabilitation from 2009 to 2013, diagnosed with ischemic stroke and CD.…”

Section: The Ipec-fiocruz Stroke Score For Patients With Chagas Diseasementioning

confidence: 99%

“…However, there are several issues regarding population type, study design and data analysis that limited the authors' conclusions. The IPEC-FIOCRUZ score was built to predict individual cardioembolic risk and the benefit of each available treatment (i.e., warfarin and acetylsalicylic acid); however, Montanaro et al [14] used this score in a population with known ischemic stroke from all etiologies (not only cardioembolic cases), in a retrospective analysis to check if the patients had a high score. As 55% of the cardioembolic events occurred in patients in the low-risk strata, Montanaro et al supposed that if the score would have been applied before the occurrence of vascular ictus, the number of patients at risk would have been underestimated.…”

Section: The Ipec-fiocruz Stroke Score For Patients With Chagas Diseasementioning

confidence: 99%

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Discussing the Score of Cardioembolic Ischemic Stroke in Chagas Disease

et al. 2020

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Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic events. Of all thromboembolic events, stroke is the most feared, due to the high probability of evolution to death or disability. Despite its importance, the actual incidence of cardioembolic ischemic stroke in Chagas disease is not completely known. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC-FIOCRUZ) score aims to propose prophylaxis strategies against cardioembolic ischemic stroke in Chagas disease based on clinical risk–benefit. To date, the IPEC-FIOCRUZ score is considered the best tool to identify patients for stroke prophylaxis in Chagas disease according the Latin American guideline and Brazilian consensus. It can prevent many cardioembolic strokes that would not be predicted, by applying the current recommendations to other cardiopathies. However, the IPEC-FIOCRUZ score still requires external validation to be used in different Chagas disease populations with an appropriate study design.

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Ischemic stroke classification and risk of embolism in patients with Chagas disease

Cited by 17 publications

References 19 publications

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

Discussing the Score of Cardioembolic Ischemic Stroke in Chagas Disease

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