Prognostic implications of clinical, electrocardiographic and hemodynamic findings in chronic Chagas' disease

Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification

“…From 606 potentially relevant studies published between 1985-2006, 12 articles met the inclusion criteria and were thereby selected for analysis (Espinosa et al 1991, Hagar & Rahimtoola 1991, Bestetti et al 1994, 1996, Carrasco et al 1994, Mady et al 1994, Garzon et al 1998, Rodriguez-Salas et al 1998, Leite et al 2003, Salles et al 2003, Viotti et al 2004, Rassi Jr et al 2006). Despite differences in the sample populations between studies (e.g., some studies included only patients with CHD while others included patients with and without manifested cardiomyopathy) and in the set of prognostic variables investigated in each study, four independent markers of increased risk of death were identified: New York Heart Association (NYHA) functional class III/IV, cardiomegaly on chest radiography, impaired Nunes et al 2008, Theodoropoulos et al 2008, Gonçalves et al 2009).…”

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

“…The systemic infection is generally acquired at an early age (6,7) by vector transmission, although an acute form of parasitic transmission has been increasingly reported in affected countries (8), and may represent a noteworthy healthcare-related problem in Europe and the United States due to migration (9). Its insidious and asymptomatic course, ranging from 10 to 30 years, and eventual advance to myocardial dysfunction, occurring in up to 30% of infected subjects, represents a marker of unfavorable prognosis for cardiovascular morbidity and mortality (10)(11)(12)(13). In this setting, persistent or permanent AF has been observed in up to one fifth of subjects bearing the chronic form (14) and represents a superimposed sign of poor prognosis (7,8).…”

Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

“…Chagas' disease has a wide variety of clinical presentations, ranging from completely asymptomatic individuals, who represent the great majority of the patients, to others with severe, sometimes fatal, cardiac alterations. Of the indicators of a poor prognosis, left ventricular dysfunction stands out as the major predictor of morbidity and mortality [3][4][5][6][7] .…”