ABSTRACT
BACKGROUND: A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES: To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS: This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS: Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS: Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.
Subject(s)
Chagas Disease , Diabetes Mellitus , Trypanocidal Agents , Trypanosoma cruzi , Female , Humans , Male , Biomarkers , Bundle-Branch Block/complications , Bundle-Branch Block/drug therapy , Chagas Disease/drug therapy , Chronic Disease , Cross-Sectional Studies , Diabetes Mellitus/drug therapy , Polymerase Chain Reaction , Trypanocidal Agents/therapeutic use , Trypanosoma cruzi/genetics , Middle Aged , AgedABSTRACT
Background Chagas disease (CD) presents an ominous prognosis. The predictive value of biomarkers and new echocardiogram parameters in adjusted models have not been well studied. Methods and Results There were 361 patients with chronic CD (57.6% men, 61±11 years of age, clinical forms: indeterminate 27.1%, cardiac 56.6%, digestive 3.6%, cardiodigestive 12.7%) included in this single-center, observational, prospective longitudinal study. Echocardiographic evaluation included strain analyses of left atrial, left ventricular (LV), and right ventricular and 3-dimensional analyses of left atrial and LV volumes. Biomarkers included cardiac troponin I, brain natriuretic peptide, transforming growth factor ß1, tumor necrosis factor, matrix metalloproteinases, and Trypanosoma cruzi polymerase chain reaction. The studied end point was a composite of CD-related mortality, heart transplant, hospital admission due to worsening heart failure, or new cardiac device insertion. Event-free survival was analyzed by multivariable regression analyses adjusted for competing risks. P values <0.05 were considered significant. The composite event occurred in 79 patients after 4.9±2.0 years follow-up. LV end-diastolic volume (hazard ratio [HR], 1.01 [95% CI, 1.00-1.02]; P=0.02), peak negative global atrial strain (HR, 1.08 [95% CI, 1.00-1.17]; P=0.04), LV global circumferential strain (HR, 1.12 [95% CI, 1.04-1.21]; P=0.003), LV torsion (HR, 0.55 [95% CI, 0.35-0.81]; P=0.003), brain natriuretic peptide (HR, 2.03 [95% CI, 1.23-3.34]; P=0.005), and positive T cruzi polymerase chain reaction (HR, 1.80 [95% CI, 1.12-2.91]; P=0.01) were end point predictors independent from age, sex, 2-dimensional echocardiographic indexes, hypertension, previous cardiac device, and CD cardiac form. Conclusions Two-dimensional strain- and 3-dimensional-derived parameters, brain natriuretic peptide, and positive T cruzi polymerase chain reaction can be useful for prediction of CD cardiovascular events.
Subject(s)
Atrial Fibrillation , Chagas Disease , Male , Humans , Female , Longitudinal Studies , Prospective Studies , Natriuretic Peptide, Brain , Echocardiography/methods , Biomarkers , Prognosis , Chagas Disease/complications , Ventricular Function, Left , Stroke VolumeABSTRACT
BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.
ABSTRACT
Abstract Background The importance of regional sympathetic denervation in the pathophysiology and prognosis of Chagas disease has been recognized. Objective To conduct a review of studies that have assessed dysautonomia in chronic Chagas heart disease. Methods The search was performed on the Medline, Pubmed, Lilacs and SciELO databases. The inclusion criteria were: original articles published in full; studies on individuals with Chagas disease, that used diagnostic methods for chagasic cardiomyopathy, and had clear inclusion and exclusion criteria. Duplicate studies, studies including children (0 to 10 years old), studies involving animals, in vitro experiments, case reports, editorials, theses, and dissertations were excluded. Results A total of 281 articles were retrieved, and 10 met the inclusion criteria and were analyzed. There was great heterogeneity as to the technique for assessing dysautonomia, groups of patients studied and classification of Chagas disease. The methods used for studying the autonomic system was immunohistochemistry (n=1), Valsalva and tilt-test (n=1), scintigraphy (n=6) and Holter monitoring (n=2). The results indicated dysautonomia in the indeterminate, digestive and cardiac forms of Chagas disease, and sympathetic denervation in the indeterminate and cardiac forms of the disease. There was agreement between areas of denervation, hypoperfusion and fibrosis, but areas of denervation were larger than those of hypoperfusion. The frequency of denervation and its extension increased from the indeterminate to the cardiac form. There was an association between extension of denervation and previous history of malignant ventricular arrhythmia. Conclusions The evidence presented in this review supports that an early diagnosis of autonomic denervation in chronic Chagas' disease allows the identification of patients with an increased risk of sudden death. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0
Subject(s)
Chagas Cardiomyopathy/complications , Chagas Disease/diagnosis , Primary Dysautonomias/complications , Primary Dysautonomias/diagnosis , Autonomic Nervous System , Chagas Disease/mortality , Early DiagnosisABSTRACT
Introdução: Pacientes soropositivos tratados com antirretrovirais(ARV) apresentam alterações do perfil lipídico. Polimorfismos dasapolipoproteínas A5 (-1131T/C) e E estão associados à dislipidemia,ocasionando aumento dos triglicerídios e resistência aos hipolipemiantes.Objetivo: Avaliar os efeitos da infecção pelo vírus da imunodeficiência humana (VIH) e dos polimorfismos das apos A5 e E sobre o perfil lipídico em pacientes ambulatoriais infectados, pré e pós-uso de ARV. Método: Estudo de coorte, observacional, prospectivo, analítico, com grupo controle, realizado entre agosto de 2008 e dezembro de 2011. Incluídos, do diagnóstico de VIH aos dias atuais, 89 pacientes de ambos os sexos, faixa etária entre 12 anos e 68 anos,sob uso ou não de terapia antirretroviral altamente ativa (HAART),atendidos no ambulatório de Cardiologia Preventiva-VIH do Hospital Universitário Antônio Pedro (Huap), UFF. Resultados: Dentre os parâmetros bioquímicos, a elevação dos triglicerídios relacionada à infecção pelo VIH e à HAART foi a mais evidente durante o estudo. Considerando o polimorfismo da apoA5, 22,4% (n = 20) dos pacientes analisados apresentaram o alelo C no seu genótipo, em comparação com 4,5% (n = 9) do grupo controle de soronegativos. Não houve diferenças significativas entre os perfis metabólicos de VIH+ que continham ou não o alelo C. Conclusão: Não houve diferença entre VIH+ carreadores do alelo C em relação àqueles não carreadoresquanto à necessidade de substituir a HAART devido à dislipidemia resistente aos hipolipemiantes. Os papéis inflamatório e aterogênico da infecção pelo VIH sobrepõem-se ou têm efeito maior do que o polimorfismo -1131T/C da apoA5 no desenvolvimento de distúrbios metabólicos.
Introduction: HIV - positive patients treated with antiretroviral(ARV) drugs have changes on lipid profile. Apolipoproteins A5(-1131TC) and E polymorphisms are associated with dyslipidemia,causing increased triglycerides and resistance to lipid-lowering drugs.Objective: Evaluate the effects of human immunodeficiency virus(HIV) infection and apoA5 and apoE polymorphisms on the lipid profileof infected outpatients, pre and post-use of ARV. Method: Cohort,observational, prospective, analytical study, with control group,between August 2008 and December 2011. Since the HIV diagnosisto the present day, 89 patients of both sexes were included, agedbetween 12 years and 68 years, under use or nonuse of highly activeantiretroviral therapy (HAART), all of them attended at PreventiveCardiology Clinic-HIV Antônio Pedro University Hospital (Huap),UFF. Results: Among the biochemical parameters, the elevation oftriglycerides related to HIV infection and to HAART was the most evidentduring the study. Considering the apoA5 polymorphism, 22.4% (n= 20) of the patients examined presented the C allele in their genotype,compared to 4.5% (n = 9) of the seronegative control group. Therewere no significant differences between the HIV metabolic profilesthat contained the C allele or not. Conclusion: There was no differencebetween HIV+ C allele carriers in relation to non-carriers on the needto replace the HAART due to lipid-lowering resistance dyslipidemia.The inflammatory and atherogenic roles of HIV infection overlap orhave greater effect than the ApoA5 -1131T/C polymorphism in thedevelopment of metabolic disorders.
Subject(s)
Humans , Male , Female , Middle Aged , Apolipoproteins A/adverse effects , HIV , HIV Seropositivity/drug therapy , Antiretroviral Therapy, Highly Active/adverse effects , Cross-Sectional Studies/methods , Risk Factors , Lipid Metabolism Disorders/chemically inducedABSTRACT
Objetivo: Avaliar alterações no perfil metabólico em pacientes VIH positivo, correlacionadas ou não com o aumento do risco para doenças cardiovasculares. Métodos: Avaliados 58 pacientes do Núcleo de Síndrome da Imunodeficiência Adquirida do Hospital Universitário Antônio Pedro, portadores do virus da Imunodeficiência humana tipo I (VIH-1), com acompanhamento ambulatorial há pelo menos seis meses ou com diagnóstico dessa infecção nesse período. Foram realizados exames para avaliar: perfil lipídico, glicemia de jejum, TOT (teste de tolerância à glicose), TGO, TGP, creatinina, dosagem de hormónios tireoideanos (TSH, T4L), PCRus, carga viral, relação CD4/CD8 e leucograma. Também realizados: eletrocardiograma, ecocardiograma transtorácico e Doppler de carótida. Resultados: Ao eletrocardiograma, a alteração mais comum foi a de repolarização ventricular difusa (ARV), apenas 1 paciente apresentou, ao ecocardiograma: aumento de VE,...
Subject(s)
Humans , Male , Female , Adult , Cardiovascular Diseases/complications , Cardiovascular Diseases/diagnosis , HIV , Acquired Immunodeficiency Syndrome/history , Risk FactorsABSTRACT
Os autores apresentam um caso de comunicação interatrial (CIA) tipo seio venoso em mulher de 60 anos, portadora de doença pulmonar obstrutiva crônica (DPOC) severa evoluindo com síndrome de Eisenmenger. Ressaltam a necessidade de diagnóstico prococe e tratamento adequado, capazes de evitar a evolução desfavorável, e chamar a atenção para a complementação diagnóstica com ecocardiograma transesofágico
