Stroke Correlates in Chagasic and Non-Chagasic Cardiomyopathies

Abstract

BackgroundAging and migration have brought changes to the epidemiology and stroke has been shown to be independently associated with Chagas disease. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology.Methodology/Principal FindingsWe performed a cross-sectional review of medical records of 790 patients with a cardiomyopathy. Patients with chagasic (329) and non-chagasic (461) cardiomyopathies were compared. There were 108 stroke cases, significantly more frequent in the Chagas group (17.3% versus 11.1%; p<0.01). Chagasic etiology (odds ratio [OR], 1.79), pacemaker (OR, 2.49), atrial fibrillation (OR, 3.03) and coronary artery disease (OR, 1.92) were stroke predictors in a multivariable analysis of the entire cohort. In a second step, the population was split into those with or without a Chagas-related cardiomyopathy. Univariable post-stratification stroke predictors in the Chagas cohort were pacemaker (OR, 2.73), and coronary artery disease (CAD) (OR, 2.58); while atrial fibrillation (OR, 2.98), age over 55 (OR, 2.92), hypertension (OR, 2.62) and coronary artery disease (OR, 1.94) did so in the non-Chagas cohort. Chagasic stroke patients presented a very high frequency of individuals without any vascular risk factors (40.4%; OR, 4.8). In a post-stratification logistic regression model, stroke remained associated with pacemaker (OR, 2.72) and coronary artery disease (OR, 2.60) in 322 chagasic patients, and with age over 55 (OR, 2.38), atrial fibrillation (OR 3.25) and hypertension (OR 2.12; p = 0.052) in 444 non-chagasic patients.Conclusions/SignificanceChagas cardiomyopathy presented both a higher frequency of stroke and an independent association with it. There was a high frequency of strokes without any vascular risk factors in the Chagas as opposed to the non-Chagas cohort. Pacemaker rhythm and CAD were independently associated with stroke in the Chagas group while age over 55 years, hypertension and atrial fibrillation did so in the non-Chagas cardiomyopathies.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…464 Stroke rates may be higher in certain subgroups, including patients with prior stroke or TIA, lower ejection fraction, LV noncompaction, peripartum cardiomyopathy, and Chagas heart disease. [464][465][466][467][468][469] Conversely, ≈10% of patients with ischemic stroke have an LV ejection fraction ≤30%.…”

Occurrence of Stroke and Reduced Ejection Fraction in Patients with Chagas Disease

“…There was also a high prevalence (50%) of CVA, which was obtained by cranial tomography, a number close to a cohort of 41.6% in the same town. 5 There were no hemorrhagic strokes and there was also no significant relationship between fibrillation atrial and stroke, this data can be explained by the use of oral anticoagulants in these patients. In addition, 54.8% of silent vascular accidents were detected in patients who had no history of stroke.…”

Sudden Cardiac Death Risk Stratification and Prevention in Chagas Disease: A Non-systematic Review of the Literature

“…The major causes of death are progression of heart failure and sudden non-arrhythmogenic death unrelated to ICDs – for example, secondary to stroke. [ 81 ] Particularly in the context of Chagas cardiomyopathy, the latter is closely associated with thromboembolic events. The distinguishing hallmark of chronic Chagas cardiomyopathy is the left ventricular apical aneurysm, which predisposes not only to VT but also to thrombus formation.…”