Prevalence and Impact of Chagas Disease Among Latin American Immigrants With Nonischemic Cardiomyopathy in Los Angeles, California

Abstract

Background— Chagas disease is a well-known cause of cardiomyopathy in Latin America; however, 300 000 individuals are estimated to have Chagas disease in the United States. This study examined the prevalence and impact of Chagas cardiomyopathy (CCM) in a US population. We hypothesized that patients with CCM would have increased morbidity and mortality when compared with patients with non-CCM. Methods and Results— This is a single-center, prospective cohort study. Enrollment criteria were new diagnosis of nonischemic cardiomyopathy (left ventricular ejection fraction ≤40%) and previous residence in Latin America for at least 12 months. Serological testing for Trypanosoma cruzi was performed at enrollment. The primary end point was all-cause mortality or heart transplantation. The secondary end point was heart failure–related hospitalization. A total of 135 patients were enrolled, with a median of 43 months of follow-up. Chagas disease was diagnosed in 25 (19%) patients. The primary end point occurred in 9 patients (36%) in the CCM group and in 11 patients (10%) in the non-CCM group (hazard ratio [HR], 4.46; 95% confidence interval, 1.8–10.8; P =0.001). The secondary end point occurred in 13 patients (52%) in the CCM group and in 35 patients (32%) in the non-CCM group (HR, 2.22; 95% confidence interval, 1.2–4.2; P =0.01). Conclusions— There is a high prevalence of Chagas disease among Latin American immigrants diagnosed with nonischemic cardiomyopathy in Los Angeles. Advanced CCM portends a poor prognosis and is associated with increased all-cause mortality/heart transplantation and heart failure–related hospitalization.

Temporal trends in the contribution of Chagas cardiomyopathy to mortality among patients with heart failure

“…In Latin America, the rate of ChC among patients with HF is reported to range between 5% and 10%,26 while in Latin American immigrants diagnosed with dilated cardiomyopathy in USA, the prevalence of ChC has varied between 13% and 19% 8 28. However, the true prevalence estimates of ChC among patients with HF might be underestimated due to the higher mortality of ChC and consequent survival bias 8. These data suggest that ChC remains a public health problem in Brazil and Latin America, and it is becoming a public health concern in countries receiving large amounts of Latin American immigrants, such as USA and Europe 11 12…”

Prevalence of Chagas Disease in the Latin American–born Population of Los Angeles

“…In our study area, CD has been associated with higher mortality. In a study of Los Angeles patients with nonischemic cardiomyopathy who had resided in Latin America for at least 12 months, the prevalence of CD was 19%, and the risk of death or heart transplant was significantly higher in this group (hazard ratio = 4.46) [36]. …”

Reactivation of Chagas disease among heart transplant recipients in the United States, 2012‐2016

“…In endemic areas, Chagas disease is a leading cause of cardiomyopathy and sudden cardiac death . In two small studies in the United States, T. cruzi infections were identified in 13%‐19% of Latin American immigrants with non‐ischemic cardiomyopathy who resided for at least one year in a country where Chagas disease is endemic . The first step to mitigate the potentially devastating effects of CDR in HT recipients is to screen transplant candidates based on epidemiological risk factors such as birth or residence in Latin America …”