Prevalence and risk factors of embolic cerebrovascular events associated with Chagas heart disease.

BACKGROUND: Patients with Chagas disease are at increased risk for stroke that may result in major clinical disability and death. Identification of risk factors involved in the genesis of thromboembolic events related to this disease may lead to improved therapeutic decision making and outcomes. OBJECTIVES: This study sought to assess the prevalence of ischemic cerebrovascular events (ICE) among patients with Chagas heart disease and to identify the risk factors associated with cardioembolism in this population. METHODS: This study involved 330 patients, 193 were men (58%), with a mean age of 49 ± 12 years with Chagas disease classified in the chronic cardiac form of the disease. Comprehensive echocardiography was performed to search a substrate for cardioembolic events, especially apical aneurysm and intracavitary thrombus. RESULTS: Most of the patients were classified as New York Heart Association classes I or II (75%) with mean left ventricular (LV) ejection fraction of 39 ± 14%. Sixty-seven patients had a previous ICE with the overall prevalence of 20%. Apical aneurysms were detected in 128 patients (39%), whereas LV mural thrombi were found in 48 patients (15%). In multivariate analysis including the potential predictors of ICE, apical aneurysm (adjusted odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.11 to 4.34; p = 0.024) and LV thrombus (adjusted OR: 2.43, 95% CI: 1.09 to 5.42; p = 0.030) emerged as important determinants of ICE, after adjusting for anticoagulation therapy. CONCLUSIONS: In a selected population referred to a tertiary center for Chagas disease that included patients with different severities of cardiac involvement, the prevalence of ICE was 20%. The presence of apical aneurysm and intracavitary thrombus were independently associated with ICE, after adjustment for other risk factors for stroke.

[Prevalence of left ventricular aneurysms among chronic Chagas disease patients from two areas in the State of Piauí, Brazil]. / Prevalência de aneurismas do ventrículo esquerdo em pacientes chagásicos crônicos de duas áreas do Estado do Piauí.

A cross-sectional study involving a cohort of 261 chronic Chagas disease patients (156 from the municipality of João Costa and 105 from São João do Piauí; 146 women and 115 men with mean age of 57.9 +/- 14.2 years) was carried out to evaluate the prevalence of left ventricle aneurysms. The cardiological evaluation was performed by means of clinical examination, resting electrocardiograms and one and two-dimensional echocardiograms. A total of 23 cases of left ventricle aneurysms (8.8%) were diagnosed: 17 (6.5%) in the apical segment, four (1.5%) in the posterior wall, one (0.4%) in the inferior wall and one (0.4%) in the interventricular septum. Five patients (1.9%) from São João do Piauí presented thrombi associated with apical aneurysms. The prevalence of left ventricle aneurysms was greater among the patients from São João do Piauí (13.3%) and among men (13.9%), with no significant difference in relation to age group. These results show that there was low prevalence of left ventricle aneurysms among patients from João Costa and high concentration of thrombi among patients from São João do Piauí.

Prevalência de aneurismas do ventrículo esquerdo em pacientes chagásicos crônicos de duas áreas do Estado do Piauí / Prevalence of left ventricular aneurysms among chronic Chagas disease patients from two areas in the State of Piauí, Brazil

Para avaliar a prevalência de aneurismas do ventrículo esquerdo, realizou-se um estudo transversal envolvendo uma coorte de 261 pacientes chagásicos crônicos (156 do município de João Costa e 105 de São do João do Piauí; 146 mulheres e 115 homens com idade média de 57,9 ± 14,2 anos). A avaliação cardiológica foi realizada por exame clínico, eletrocardiograma de repouso e ecocardiograma uni e bidimensional. Foram diagnosticados 23 (8,8 por cento) aneurismas do ventrículo esquerdo: 17 (6,5 por cento) no ápice, quatro (1,5 por cento) na parede posterior, um (0,4 por cento) na parede inferior e um (0,4 por cento) no septo interventricular. Cinco (1,9 por cento) pacientes de São João do Piauí apresentaram trombos associados com aneurismas apicais. A prevalência de aneurismas do ventrículo esquerdo foi maior entre os pacientes de São João do Piauí (13,3 por cento) e entre os homens (13,9 por cento), com diferença não significativa em função da faixa etária. Esses resultados revelam baixa prevalência de aneurismas do ventrículo esquerdo entre os pacientes de João Costa e elevada concentração de trombos entre os pacientes de São João do Piauí.

A cross-sectional study involving a cohort of 261 chronic Chagas disease patients (156 from the municipality of João Costa and 105 from São João do Piauí; 146 women and 115 men with mean age of 57.9 ± 14.2 years) was carried out to evaluate the prevalence of left ventricle aneurysms. The cardiological evaluation was performed by means of clinical examination, resting electrocardiograms and one and two-dimensional echocardiograms. A total of 23 cases of left ventricle aneurysms (8.8 percent) were diagnosed: 17 (6.5 percent) in the apical segment, four (1.5 percent) in the posterior wall, one (0.4 percent) in the inferior wall and one (0.4 percent) in the interventricular septum. Five patients (1.9 percent) from São João do Piauí presented thrombi associated with apical aneurysms. The prevalence of left ventricle aneurysms was greater among the patients from São João do Piauí (13.3 percent) and among men (13.9 percent), with no significant difference in relation to age group. These results show that there was low prevalence of left ventricle aneurysms among patients from João Costa and high concentration of thrombi among patients from São João do Piauí.

Aspectos epidemiológicos, clínicos e parasitológicos da doenca de Chagas em Mato Grosso do Sul / Epidemiological, clinical and parasitological aspects of Chagas' disease in Mato Grosso do Sul State

Com o objetivo de avaliar aspectos epidemiológicos, clínicos e parasitológicos da doenca de Chagas crônica, em pacientes do Hospital Universitário da Universidade Federal de Mato Grosso do Sul, realizamos um estudo seccional envolvendo 120 chagásicos e 120 controles não-chagásicos, de ambos os sexos, com idades de 16 a 82 anos. Os aspectos epidemiológicos foram avaliados por questionário, a cardiopatia por exame clínico, eletrocardiograma convencional, radiologia e ecodopplercardiograma e a presenca de Trypanosoma cruzi no sangue por xenodiagnóstico e teste da reacão em cadeia da polimerase. Os resultados mostraram predominância de alóctones com baixa escolaridade e referência de contato prévio com triatomíneos entre os chagásicos. Abortamento espontâneo foi mais freqüente nas mulheres chagásicas. A cardiopatia devido ao componente chagásico foi estimada em 20,2 por cento. Apresentou-se com 7,5 por cento de cardiomegalia, 6,2 por cento de aneurisma de ventrículo esquerdo e com predominância de dispnéia, palpitacões e hipertensão arterial. O xenodiagnóstico foi positivo em 26,1 por cento dos chagásicos enquanto a PCR foi positiva em 53,7 por cento. A análise dos resultados indicou que a doenca de Chagas no grupo estudado apresenta características clínicas e parasitológicas que revelam peculiaridades regionais.

[Epidemiological, clinical and parasitological aspects of Chagas' disease in Mato Grosso do Sul State]. / Aspectos epidemiológicos, clínicos e parasitológicos da doença de Chagas em Mato Grosso do Sul.

With the objective of evaluating epidemiologic, clinical and parasitologic aspects of chronic Chagas' disease in patients from the University Hospital of the Federal University of Mato Grosso do Sul, a cross-sectional study was performed with groups of 120 chagasic and non-chagasic patients aged from 16 to 82 years. Epidemiologic aspects were evaluated by means of a questionnaire, cardiopathy by clinical examination, conventional electrocardiogram, radiology and Doppler echocardiograms (only in chagasic patients) and the presence of Trypanosoma cruzi in the blood stream by way of xenodiagnosis and polymerase chain reaction test. The results obtained indicated that the chagasic patients are predominantly alloctones with low-grade schooling, and were exposed to triatomines. The frequency of spontaneous abortion was higher in chagasic women. Chronic chagasic cardiopathy, estimated to occur in 20.2% of the patients, showed 7.5% cardiomegaly, 6.2% aneurysm of the left ventricle, and with a predominance of dyspnea, palpitations and arterial hypertension. Xenodiagnosis was positive for 26.1% of the chagasics and the PCR was positive for 53.7%, and was significantly higher in males and alloctones. An analysis of the results shows that Chagas' disease, in the group studied, presented clinical and parasitologic characteristics demonstrating significant regional differences.

[Ventricular aneurysm in chronic Chagas' disease. The experience of the Instituto Nacional de Cardiología Ignacio Chávez]. / Aneurisma ventricular en la cardiopatía chagásica crónica. Experiencia del Instituto Nacional de Cardiología "Ignacio Chávez".

This work describes the incidence of ventricular aneurysms in patients with angiographically normal epicardial coronary arteries, who have epidemiological, clinical and serologic features suggesting chronic Chagasic cardiomyopathy (C.C.C). Eight out of 22 patients (36%) with such features had ventricular aneurysm. Three were located on the apex, 3 anteroapical and 2 basal. All patients had arrhythmia. In a case it was necessary a surgical approach to control a medically intractable life threatening ventricular tachyarrhythmia. In regard of the incidence of ventricular aneurysms in C.C.C., our results are in agreement with published experiences in South America. Surgical treatment of chagasic aneurysm should be considered when medical treatment is unable to control dangerous arrhythmia and an electrophysiological study supports this approach.