Chagas disease mortality during the coronavirus disease 2019 pandemic: A Brazilian referral center experience.

BACKGROUND: We investigated the mortality rates of patients with Chagas disease (CD) during the coronavirus disease 2019 (COVID-19) pandemic and assessed the association between this mortality and CD clinical presentation and comorbidities. METHODS: This was an observational retrospective study with clinical data retrieved from medical records. RESULTS: Comorbidities were more prevalent among patients who died from COVID-19 than those who died from other causes. The proportion of patients according to CD clinical presentation was similar between the two groups. CONCLUSIONS: The prevalence of comorbidities seems to be related to a poorer prognosis in CD and COVID-19.

Temporal changes in the clinical-epidemiological profile of patients with Chagas disease at a referral center in Brazil.

INTRODUCTION: We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS: This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS: A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients' levels of education. CONCLUSIONS: The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.

Progression Rate from the Indeterminate Form to the Cardiac Form in Patients with Chronic Chagas Disease: Twenty-Two-Year Follow-Up in a Brazilian Urban Cohort.

Most patients with chronic Chagas disease (CD) present the indeterminate form and are at risk to develop the cardiac form. However, the actual rate of progression to the cardiac form is still unknown. METHODS: In total, 550 patients with the indeterminate CD form were followed by means of annual electrocardiogram at our outpatient clinic. The studied endpoint was progression to cardiac form defined by the appearance of electrocardiographic changes typical of CD. The progression rate was calculated as the cumulative progression rate and the incidence progression rate per 100 patient years. RESULTS: Thirty-seven patients progressed to the CD cardiac form within a mean of 73 ± 4 8 months of follow-up, which resulted in a 6.9% cumulative progression rate and incidence rate of 1.48 cases/100 patient years. Patients who progressed were older (mean age 47.8 ± 12.2 years), had a higher prevalence of associated heart diseases (p < 0.0001), positive xenodiagnosis (p = 0.007), and were born in the most endemic Brazilian states (p = 0.018). Previous co-morbidities remained the only variable associated with CD progression after multivariate Cox proportional hazards regression analysis (p = 0.002). CONCLUSION: The progression rate to chronic CD cardiac form is low and inferior to rates previously reported in other studies.

SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023 / Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas ­ 2023

Em 2021, por iniciativa de seu então presidente, Dr. Marcelo Queiroga Cartaxo Lopes, a Sociedade Brasileira de Cardiologia (SBC) nos comissionou para a coordenação dos trabalhos, visando à elaboração da nova diretriz relativa à doença de Chagas (DC). Justificava-se a empreitada, uma vez que, desde 2011, a SBC não se responsabilizava diretamente por uma diretriz no contexto. Diversamente daquela, publicada há mais de uma década nos Arquivos Brasileiros de Cardiologia, a atual não mais seria "latino-americana", mas passaria a contar essencialmente "apenas" com contingente expressivo de colaboradores nacionais. A plêiade ilustre de investigadores ativos no contexto, que então convocamos, seria representativa de uma equipe ainda mais dilatada de profissionais dos mais diversificados pontos do país, que se envolvem e contribuem diretamente para o avanço no combate à DC, e passou a responder integralmente pela autoria desta diretriz, conforme explicitado abaixo.

Chagas disease mortality during the coronavirus disease 2019 pandemic: A Brazilian referral center experience

ABSTRACT Background We investigated the mortality rates of patients with Chagas disease (CD) during the coronavirus disease 2019 (COVID-19) pandemic and assessed the association between this mortality and CD clinical presentation and comorbidities. Methods: This was an observational retrospective study with clinical data retrieved from medical records. Results: Comorbidities were more prevalent among patients who died from COVID-19 than those who died from other causes. The proportion of patients according to CD clinical presentation was similar between the two groups. Conclusions: The prevalence of comorbidities seems to be related to a poorer prognosis in CD and COVID-19.

Cardiosphere-derived cells do not improve cardiac function in rats with cardiac failure.

BACKGROUND: Heart failure represents an important public health issue due to its high costs and growing incidence worldwide. Evidence showing the regenerative potential of postmitotic heart tissue has suggested the existence of endogenous cardiac stem cells in adult hearts. Cardiosphere-derived cells (CDC) constitute a candidate pool of such cardiac stem cells. Previous studies using acute myocardial infarction (MI) models in rodents demonstrated an improvement in cardiac function after cell therapy with CDC. We evaluated the therapeutic potential of CDC 60 days after MI in a rat model. METHODS: CDC were obtained from human discarded myocardial tissue and rat hearts by enzymatic digestion with collagenase II. At 10-15 days after isolation, small, round, phase-bright cells (PBCs) appeared on top of the adherent fibroblast-like cells. The PBCs were collected and placed on a nonadherent plate for 2 days, where they formed cardiospheres which were then transferred to adherent plates, giving rise to CDC. These CDC were characterized by flow cytometry. Wistar rats were submitted to MI through permanent occlusion of the anterior descending coronary artery. After 60 days, they were immunosuppressed with cyclosporine A during 10 days. On the third day, infarcted animals were treated with 5 × 105 human CDC (hCDC) or placebo through intramyocardial injection guided by echocardiogram. Another group of animals was treated with rat CDC (rCDC) without immunosuppression. hCDC and rCDC were stably transduced with a viral construct expressing luciferase under control of a constitutive promoter. CDC were then used in a bioluminescence assay. Functional parameters were evaluated by echocardiogram 90 and 120 days after MI and by Langendorff at 120 days. RESULTS: CDC had a predominantly mesenchymal phenotype. Cell tracking by bioluminescence demonstrated over 85% decrease in signal at 5-7 days after cell therapy. Cardiac function evaluation by echocardiography showed no differences in ejection fraction, end-diastolic volume, or end-systolic volume between groups receiving human cells, rat cells, or placebo. Hemodynamic analyses and infarct area quantification confirmed that there was no improvement in cardiac remodeling after cell therapy with CDC. CONCLUSION: Our study challenges the effectiveness of CDC in post-ischemic heart failure.

Temporal changes in the clinical-epidemiological profile of patients with Chagas disease at a referral center in Brazil

Abstract INTRODUCTION We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients' levels of education. CONCLUSIONS The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.

Torção do ventrículo esquerdo é reduzida e sua dinâmica alterada em estágios avançados da forma cardíaca da doença de Chagas / Decreased left ventricular torsion with distorted dynamics at advanced stages of Chagas' heart disease

Fundamentos: A expressão mais grave da doença de Chagas é a insuficiência cardíaca (IC). A torção do ventrículo esquerdo (VE) é reduzida na IC de outras etiologias e pode ser importante para avaliação do desempenho cardíaco na doença de Chagas. Objetivo: Avaliar a torção do VE em diferentes estágios da doença de Chagas. Métodos: Foi realizado estudo longitudinal entre março e outubro de 2010 avaliando ecocardiogramas de 17 controles e 139 pacientes sendo 44 da forma indeterminada (sem cardiopatia aparente), 27 pacientes no estágio A da forma cardíaca (alterações limitadas ao eletrocardiograma), 31 no estágio B (sem clínica de IC com alteração da função sistólica global ou segmentar do VE), 26 no estágio C (IC compensável) e 11 no estágio D (IC refratária). Resultados: A torção do VE foi similar entre controles (12,7±3,9º), indeterminados (11,7±5,5º) e pacientes no estágio A (9,9±4,6º), mas foi progressivamente menor nos pacientes do estágio B ao D (B:8,6±6,3º; C:4,7±4,1º; D:0,1±3,1º; p<0,0001). Enquanto os controles apresentaram padrão normal de torção do VE com rotação apical anti-horária e rotação basal no sentido horário, o padrão de torção foi anormal em 15% dos pacientes indeterminados e no estágio A; 37% dos pacientes no estágio B; 35% dos pacientes no estágio C; e 82% dos pacientes no estágio D. Conclusões: A torção do VE é reduzida e sua dinâmica progressivamente mais alterada conforme a doença de Chagas atinge estágios mais avançados de acometimento cardíaco. A contribuição desses eventos para o prognóstico da doença de Chagas ainda deve ser estabelecida.

Torção do ventrículo esquerdo é reduzido e sua dinâmica alterada em estágios avançados da forma cardíaca da doença de Chagas / Decreased left ventricular torsion with distorted dynamics at advanced stages of Chagas'heart disease

Fundamentos: A expressão mais grave da doença de Chagas é a insuficiência cardíaca (IC). A torção do ventrículo esquerdo (VE) é reduzida na IC de outras etiologias e pode ser importante para avaliação do desempenho cardíaco na doença de Chagas. Objetivo: Avaliar a torção do VE em diferentes estágios dadoença de Chagas. Métodos: Foi realizado estudo longitudinal entre março e outubro de 2010 avaliando ecocardiogramas de 17 controles e 139 pacientes sendo 44 da forma indeterminada (sem cardiopatia aparente), 27 pacientes no estágio A da forma cardíaca (alterações limitadas ao eletrocardiograma), 31 no estágio B (sem clínica de IC com alteração da função sistólica global ou segmentar do VE), 26 no estágio C (IC compensável) e 11 no estágio D (IC refratária).Resultados: A torção do VE foi similar entre controles (12,7±3,9º), indeterminados (11,7±5,5º) e pacientes no estágio A (9,9±4,6º), mas foi progressivamente menor nospacientes do estágio B ao D (B:8,6±6,3º; C:4,7±4,1º; D:0,1±3,1º;p<0,0001). Enquanto os controles apresentaram padrão normal de torção do VE com rotação apical anti-horária erotação basal no sentido horário, o padrão de torção foi anormal em 15 dos pacientes indeterminados e noestágio A; 37 dos pacientes no estágio B; 35 dos pacientes no estágio C; e 82 dos pacientes no estágio D.Conclusões: A torção do VE é reduzida e sua dinâmica progressivamente mais alterada conforme a doença de Chagas atinge estágios mais avançados de acometimento cardíaco. A contribuição desses eventos para o prognósticoda doença de Chagas ainda deve ser estabelecida.