Risk stratification in a Brazilian hospital-based cohort of 1220 outpatients with heart failure: role of Chagas' heart disease

Freitas, Humberto Felício Gonçalves de; Chizzola, Paulo Roberto; Paes, Ângela Tavares; Lima, Antônio Carlos Pedroso de; Mansur, Alfredo José

doi:10.1016/j.ijcard.2004.05.025

Cited by 186 publications

(148 citation statements)

References 39 publications

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“…The high frequency of heart failure in deaths related to Chagas' disease suggests poor prognosis for patients with this condition, which seems to be associated with increased risk of death, as compared to patients with heart failure due to other etiologies 23 .…”

Section: Martins-melo Fr Et Al -Causes Of Death Related To Chagas Dismentioning

confidence: 99%

Multiple causes of death related to Chagas' disease in Brazil, 1999 to 2007

Martins-Melo

Ramos

Alencar

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction:Chagas' disease is a major public health problem in Brazil and needs extensive and reliable information to support consistent prevention and control actions. This study describes the most common causes of death associated with deaths related to Chagas' disease (underlying or associated cause of death). Methods: Mortality data were obtained from the Mortality Information System of the Ministry of Health (approximately 9 million deaths). We analyzed all deaths that occurred in Brazil between 1999 and 2007, where Chagas' disease was mentioned on the death certificate as underlying or associated cause (multiple causes of death). Results: There was a total of 53,930 deaths related to Chagas' disease, 44,543 (82.6%) as underlying cause and 9,387 (17.4%) as associated cause. The main diseases and conditions associated with death by Chagas' disease as underlying cause included direct complications of cardiac involvement, such as conduction disorders/arrhythmias (41.4%) and heart failure (37.7%). Cerebrovascular disease (13.2%), ischemic heart disease (13.2%) and hypertensive diseases (9.3%) were the main underlying causes of deaths in which Chagas' disease was identified as an associated cause. Conclusions: Cardiovascular diseases were often associated with deaths related to Chagas' disease. Information from multiple causes of death recorded on death certificates allows reconstruction of the natural history of Chagas' disease and suggests preventive and therapeutic potential measures more adequate and specifics.Keywords: Chagas' disease. Mortality. Underlying cause of death. Multiple causes of death. Epidemiology. Brazil.The World Health Organization (WHO) recommends mortality statistics to be presented by the underlying cause of death. This is defined as the disease or injury, which initiated the cascade of events leading directly to death, or the circumstances of accident or violence that produced fatal injury 1 . However, especially for infectious and parasitic diseases, there is a need for more comprehensive information on fatal events. Additionally, there is a clear relevance to consider all causes of death recorded on death certificates. These include in addition to the underlying causes of death the associated causes that increase the risk of complications, and other contributing causes not directly related to the process that led to death. These three groups together are called multiple causes of death 2,3 .In Brazil, with significant reduction of vector and blood-borne transmission, the number of cases of acute form of Chagas' disease has been drastically reduced in most endemic areas 4 . In addition, both increased knowledge about the natural history of disease and better effectiveness of clinical and surgical interventions, led to the reduction of specific mortality and increased survival of infected individuals 5 . Recent estimates amount to 2 to 3 million individuals infected with the causing agent Trypanosoma cruzi in Brazil [6][7][8] . A large proportion of these cases occurred in o...

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Section: Martins-melo Fr Et Al -Causes Of Death Related To Chagas Dismentioning

confidence: 99%

Multiple causes of death related to Chagas' disease in Brazil, 1999 to 2007

Martins-Melo

Ramos

Alencar

et al. 2012

Rev. Soc. Bras. Med. Trop.

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“…In Mexico, the reported seroprevalence rates have ranged from 19.4% in Yucatán to 82.5% in Chiapas [14][15] ; in Brazil, the prevalence has been reported to range from 20% in São Paulo to 48% in Bahia [5][6][7][8][9] . All authors agree that seroprevalence is higher in HF patients; however, the point of interest is to ascertain whether the HF syndrome in seropositive patients is a consequence of CChC.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with Chagas disease have a worse prognosis than patients with HF resulting from other etiologies 5,8,20 . This poor prognosis has been associated with the presence of ventricular tachycardia, low ejection fraction, bradycardia, decreased systolic pressure, decreased VO 2 max, activation of the renin-angiotensin system, and elevated levels of cytokines [7][8] .…”

Section: Discussionmentioning

confidence: 99%

“…In Latin America, CChC is considered one of the leading causes of HF 5 , and the prevalence of anti-Trypanosoma cruzi antibodies in patients with HF have been broadly studied in Brazil, reporting values from 20 to 48% [5][6][7][8][9] . Heart failure is a final stage of CChC.…”

Section: Prevalência De Anticorpos Anti-trypanosoma Cruzi E Marcadorementioning

confidence: 99%

“…Aumento atrial esquerdo e hipertrofia ventricular foram as mais frequentemente observadas em pacientes com IC soronegativos. PCR, IL6, ILβ1, IL2 e FNTα foram elevados em 94, 5,48,17,8,13,7 e em 6,9% dos pacientes com IC, respectivamente; os níveis de IL-2 foram associados com IC chagásica. Conclusões: Uma alta prevalência de AgTc foi observada em pacientes com IC na região centro-oeste da Venezuela, cujos aspectos epidemiológicos, clínicos e inflamatórios são discretamente diferentes dos soronegativos.…”

Section: Introductionunclassified

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Prevalence of Trypanosoma cruzi antibodies and inflammatory markers in uncompensated heart failure

Bravo-Tobar

Parra²,

Pérez

et al. 2011

Rev. Soc. Bras. Med. Trop.

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Introduction: Heart failure (HF) represents the final stage of chronic chagasic cardiomyopathy (CChC). The diagnosis of CChC is based on the demonstration of anti-Trypanosoma cruzi antibodies (aTcAg) and clinical and epidemiological data. In Venezuela, there are no data about the prevalence of chagasic HF. The aim of this study was to determine the epidemiological, clinical, and inflammatory risk factors associated with seronegative or seropositive HF patients. Methods: We performed a cross-sectional study in the Venezuelan central-west states among a healthy rural population and in patients admitted to the emergency room with uncompensated HF. Results: The seroprevalence rates of Trypanosoma cruzi antibodies were 11.2% and 40.1% in the healthy population and in HF patients, respectively. Seropositivity in healthy individuals was associated with age, knowledge on triatomine vectors, and having seen wild reservoirs in the house; in HF patients, with contact with the vector and previous clinical diagnosis of Chagas' disease; and in both groups taken together, with age, knowledge on triatomines, and HF. Seropositive patients had prolonged QRS, decreased ejection fraction, and high serum magnesium, all significant as compared with HF seronegative cases. Left atrium enlargement and ventricular hypertrophy were most frequently observed in HF seronegative patients. CRP, IL6, ILβ1, IL2, and FNTα were elevated in 94.5%, 48%, 17.8%, 13.7%, and 6.9% of HF patients, respectively, but only IL2 levels were associated with chagasic HF. Conclusions: There is a high prevalence of aTcAg in HF patients from the central-west region of Venezuela, and their epidemiological, clinical, and inflammatory features are discreetly different as compared with those of seronegative cases.

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