Stroke History and Chagas Disease Are Independent Predictors of Silent Cerebral Microembolism in Patients with Congestive Heart Failure

Jesus, Pedro Antônio Pereira de; Neville, Iuri Santana; Cincura, Carolina; Menezes, Daniela F.; Vieira-de-Melo, Rodrigo M.; Lacerda, Amanda Mota; Viana, Leila C.; Pereira, Daniela; Ribeiro-dos-Santos, Valter; Reis, Francisco José Farias Borges dos; Macedo, Cristiano; Oliveira‐Filho, Jamary

doi:10.1159/000319892

Cited by 8 publications

(3 citation statements)

References 38 publications

(35 reference statements)

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“…al. demonstrated an independent relationship between the signs of microembolism on transcranial Doppler and the history of stroke in patients with Chagas disease 25 . These data further corroborate the hypothesis that several risk factors are involved in addition to those already elucidated.…”

Section: Stroke In the Setting Of Chagas Disease: An Overview Of Prev...mentioning

confidence: 93%

Stroke in Chagas disease: from pathophysiology to clinical practice

Lage

Tupinambás

Pádua

et al. 2022

Rev. Soc. Bras. Med. Trop.

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Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.

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Section: Stroke In the Setting Of Chagas Disease: An Overview Of Prev...mentioning

confidence: 93%

Stroke in Chagas disease: from pathophysiology to clinical practice

Lage

Tupinambás

Pádua

et al. 2022

Rev. Soc. Bras. Med. Trop.

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“…Also, microembolic signals occurred independently of left ventricle function in chagasic patients. The authors speculate alternative mechanisms, besides heart failure, to explain microemboli, such as some kind of inflammatory reaction [41]. As we know that silent microemboli may be related to increased risk of ischemic stroke, it is an indirect demonstration of a greater stroke risk among chagasic patients.…”

Section: Chagas Disease and Strokesmentioning

confidence: 99%

Neurologic Manifestations of Chagas Disease

2011

Curr Neurol Neurosci Rep

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Chagas disease is endemic in Latin America and has become an emerging problem in developed countries because of international migrations. The protozoan Trypanosoma cruzi is the etiologic agent and the disease is divided into two phases. The acute phase is mostly asymptomatic or presents with unspecific symptoms. Rarely, a severe and often fatal form occurs in immunosuppressed patients or infants, characterized by meningoencephalitis (sometimes including brain tumor-like lesions) and myocarditis. The chronic phase consists of an indeterminate, asymptomatic form followed by digestive, cardiac, or neurologic symptoms in about 30% of infected patients. Autonomous nervous system dysfunction is prominent in chagasic patients and participates in the affliction of the target organs. Stroke, mainly cardioembolic, may occur in the chronic phase, but other stroke etiologies are reported. Embolic sources and inflammation are thought to play a role in stroke mechanisms. Specific treatment for Chagas disease is scarce and preventive measures are needed.

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“… 18 Jesus et al, searching for signs of microemboli on transcranial Doppler in a cardiomyopathy clinic, showed that microemboli are more frequent among patients with CCC compared to patients with other heart diseases, independent of left ventricle function, and are also associated with silent heart attacks. 19 Silent brain infarcts have also been described by another author. 10 It is speculated that inflammation 18 and thrombogenic factors 20 play a role in this mechanism, but these need to be further clarified.…”

Section: Introductionmentioning

confidence: 84%

Clinical assessment, neuroimaging and immunomarkers in Chagas disease study (CLINICS): rationale, study design and preliminary findings

Oliveira‐Filho

Dias

Jesus

et al. 2012

Dement. neuropsychol.

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Chagas disease (CD) is an important cause of cardiomyopathy and stroke in Brazil. Brain infarcts and atrophy seem to occur independently of cardiomyopathy severity and cognitive impairment is understudied.ObjectiveCompare the prevalence of brain magnetic resonance imaging abnormalities between patients with or without CD; determine if inflammatory biomarkers are increased in CD; and determine the efficacy of aspirin in reducing the rate of microembolization in these patients.Methods500 consecutive patients with heart failure will undergo a structured cognitive evaluation, biomarker collection and search for microembolic signals on transcranial Doppler. The first 90 patients are described, evaluated with cognitive tests and brain magnetic resonance imaging to measure N-acetyl aspartate (NAA), choline (Cho), myo-inositol (MI) and creatine (Cr).ResultsMean age was 55±11 years, 51% female, 38 (42%) with CD. Mean NAA/Cr ratio was lower in patients with CD as compared to other cardiomyopathies. Long-term memory and clock-drawing test were also significantly worse in CD patients. In the multivariable analysis correcting for ejection fraction, age, sex and educational level, reduced NAA/Cr (p=0.006) and cognitive dysfunction (long-term memory, p=0.023; clock-drawing test, p=0.015) remained associated with CD.ConclusionIn this preliminary sample, CD was associated with cognitive impairment and decreased NAA/Cr independently of cardiac function or educational level.

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Stroke History and Chagas Disease Are Independent Predictors of Silent Cerebral Microembolism in Patients with Congestive Heart Failure

Cited by 8 publications

References 38 publications

Stroke in Chagas disease: from pathophysiology to clinical practice

Stroke in Chagas disease: from pathophysiology to clinical practice

Neurologic Manifestations of Chagas Disease

Clinical assessment, neuroimaging and immunomarkers in Chagas disease study (CLINICS): rationale, study design and preliminary findings

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