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1.
Heart Lung Circ ; 28(9): 1427-1435, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31272827

RESUMO

The majority of global cardiovascular disease burden occurs in low- and middle-income countries (LMIC) and indigenous populations. Although common diseases, such as ischaemic heart disease, cause significant burden, there are also neglected diseases. Forgotten by many, these diseases-including rheumatic heart disease, endomyocardial fibrosis and Chagas cardiomyopathy-continue to take a tremendous toll on a large proportion of the world's population. Whilst the technology of echocardiography continues to evolve in many high-income countries, low resource countries are working out how to make this vital tool available and affordable for the most remote and poorest populations. This paper aims to highlight the neglected cardiovascular diseases and their echocardiographic features. It also highlights the latest research in relation to portable echocardiography, task shifting and disease screening. The authors make recommendations in relation to future directions, including making echocardiography an affordable and accessible tool for all.


Assuntos
Cardiomiopatia Chagásica , Ecocardiografia/economia , Fibrose Endomiocárdica , Pobreza , Cardiopatia Reumática , Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/economia , Fibrose Endomiocárdica/diagnóstico por imagem , Fibrose Endomiocárdica/economia , Humanos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/economia
2.
PET Clin ; 14(2): 281-291, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826025

RESUMO

Ventricular arrhythmias (VAs) are a major cause of morbidity and mortality, especially in patients with structural heart disease. In the last decade, advanced imaging modalities, such as cardiac MR and nuclear imaging, have progressively demonstrated to play a central role in the diagnosis and management of patients presenting with VAs. PET is acquiring a growing role thanks to its capability to assess different pathophysiologic aspects of the arrhythmogenic substrate by evaluating abnormal myocardial perfusion, presence of inflammation, myocardial viability, and sympathetic innervation. This review describes the principles and main clinical applications of PET imaging in the setting of VAs.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Cardiomiopatia Chagásica/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Miocardite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Recidiva , Sarcoidose/diagnóstico por imagem
3.
Rev Soc Bras Med Trop ; 51(6): 827-830, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517538

RESUMO

INTRODUCTION: We investigated the occurrence of coronary sinus abnormalities in the indeterminate form of Chagas disease (CD). METHODS: Differences between the maximum and minimum diameters of the coronary sinus (∆%) on echocardiography were evaluated in individuals with the indeterminate form of CD (n=14) and those without (n=16) CD. The association of the difference with abnormalities detected by echocardiography and myocardial scintigraphy was assessed. RESULTS: The mean Δ% values did not differ significantly between the groups. There was no correlation of the measurements with echocardiographic and myocardial scintigraphy findings. CONCLUSIONS: The coronary sinus evaluation revealed no differences between the groups.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Seio Coronário/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Cardiomiopatia Chagásica/fisiopatologia , Seio Coronário/parasitologia , Seio Coronário/fisiopatologia , Ecocardiografia , Feminino , Humanos , Masculino , Disfunção Ventricular Esquerda/fisiopatologia
4.
J Am Coll Cardiol ; 72(21): 2567-2576, 2018 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30466514

RESUMO

BACKGROUND: Patients with chronic Chagas cardiomyopathy (CCC) have pronounced myocardial fibrosis, which may predispose to sudden cardiac death, despite well-preserved global left ventricular (LV) systolic function. Cardiac magnetic resonance can assess myocardial fibrosis by late gadolinium enhancement (LGE) sequences. OBJECTIVES: This prospective study evaluated if the presence of scar by LGE predicted hard adverse outcomes in a cohort of patients with CCC. METHODS: A prospective cohort of 140 patients with CCC (52.1% female; median age 57 years [interquartile range: 45 to 67 years]) were included. Cardiac magnetic resonance cine and LGE imaging were performed at enrollment with a 1.5-T scanner. The primary endpoint was the combination of cardiovascular death and sustained ventricular tachycardia. The secondary endpoint was the combination of cardiovascular death, sustained ventricular tachycardia, or cardiovascular hospitalization during follow-up. RESULTS: After a median of 34 months (interquartile range: 24 to 49 months) of follow-up, 11 cardiovascular deaths, 3 episodes of sustained ventricular tachycardia, and 20 cardiovascular hospitalizations were recorded. LGE scar was present in 71.4% of the patients, with the lateral, inferolateral, and inferior walls most commonly affected. Patients with positive LGE had lower LV ejection fraction and higher LV end-diastolic volume and LV mass than patients without LGE. No difference in other cardiovascular risk factors was noted. Patients with scar had higher event rates compared with those without scar for the primary (p = 0.043) and the secondary (p = 0.016) endpoint. In multivariable analysis, age and LGE area were related to primary outcome; age and lower LV ejection fraction were related to the secondary outcome. The pattern of LGE myocardial fibrosis was transmural, focal, or diffuse scar in approximately one-third of patients with positive LGE, and no pattern was specifically related to outcomes. CONCLUSIONS: In patients with CCC, presence of scar by LGE is common and is strongly associated with major adverse outcomes.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/mortalidade , Cicatriz/diagnóstico por imagem , Cicatriz/mortalidade , Ventrículos do Coração/diagnóstico por imagem , Adulto , Idoso , Doença Crônica , Estudos de Coortes , Eletrocardiografia/tendências , Feminino , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Prognóstico , Estudos Prospectivos
5.
J Am Coll Cardiol ; 72(21): 2577-2587, 2018 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30466515

RESUMO

BACKGROUND: Myocardial fibrosis (MF) according to cardiac magnetic resonance (CMR) is a frequent finding in Chagas cardiomyopathy and has been associated with risk factors of poor outcome. OBJECTIVES: The goal of this study was to determine the prognostic value of MF in predicting combined hard events or all-cause mortality. METHODS: Patients with Chagas cardiomyopathy who had a previous CMR evaluation were included, and clinical follow-up was retrospectively obtained. The primary outcome was a combination of all-cause mortality, heart transplantation, antitachycardia pacing or appropriate shock from an implantable cardioverter-defibrillator, and aborted sudden cardiac death; the secondary outcome was all-cause mortality. RESULTS: A total of 130 patients were included; mean age was 53.6 ± 11.5 years, and 53.9% were female. The majority of patients reported no symptoms of heart failure or arrhythmia, but electrocardiographic and echocardiographic abnormalities were common. On CMR, left ventricular dilatation and dysfunction were frequent, and MF was found in 76.1%, with a mean mass of 15.2 ± 16.5 g. Over a median follow-up of 5.05 years, 58 (44.6%) patients reached the combined endpoint, and 45 (34.6%) patients died. MF was associated with the primary outcome as a continuous variable (adjusted hazard ratio: 1.031; 95% CI: 1.013 to 1.049; p = 0.001) and as a categorical variable (MF ≥12.3 g) (adjusted hazard ratio: 2.107; 95% CI: 1.111 to 3.994; p = 0.022), independently from the Rassi risk score. MF expressed as a continuous variable was also associated with all-cause mortality (adjusted hazard ratio: 1.028; 95% CI: 1.005 to 1.051; p = 0.017) independently from the Rassi risk score. CONCLUSIONS: MF is an independent predictor of adverse outcome in Chagas cardiomyopathy. Our data may support the use of CMR in better risk-stratifying this population and possibly guiding therapy.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/mortalidade , Miocárdio/patologia , Adulto , Idoso , Estudos de Coortes , Ecocardiografia/tendências , Feminino , Fibrose/diagnóstico por imagem , Fibrose/mortalidade , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
6.
J Nucl Med ; 59(9): 1430-1436, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29700129

RESUMO

Altered myocardial perfusion is a common finding in chronic Chagas cardiomyopathy (CCC), but its underlying histologic changes have not been elucidated. We investigated the occurrence of myocardial perfusion defects (MPDs) and the correlated regional changes to histology in an experimental model of CCC in hamsters. Methods: Female Syrian hamsters (n = 34) were infected with 3.5 × 104 to 105 trypomastigote forms of Trypanosoma cruzi, Y strain, and 6-10 mo afterward underwent in vivo imaging including resting 99mTc-sestamibi SPECT, segmental and global left ventricular function assessment using 2-dimensional echocardiography, and 18F-FDG PET for evaluation of myocardial viability. Histologic analysis included quantification of fibrosis, inflammatory infiltration, and the diameter and density of myocardial microcirculation. Results: MPDs were present in 17 (50%) of the infected animals. Histologic analysis revealed no transmural scar in segments with an MPD, and normal or mildly reduced 18F-FDG uptake, indicating viable myocardium. Infected animals with an MPD, in comparison to infected animals without an MPD and control animals, showed a lower left ventricular ejection fraction (P = 0.012), a higher wall motion score index (P = 0.004), and a higher extent of inflammatory infiltration (P = 0.018) but a similar extent of fibrosis (P = 0.15) and similar microvascular diameter and density (P > 0.05). Segments with an MPD (n = 65), as compared with normally perfused regions in the same animal (n = 156), showed a higher wall motion score index (P = 0.005) but a similar extent of inflammatory infiltration, a similar extent of fibrosis, and a similar microvascular diameter and density. Conclusion: Resting MPDs are frequent in experimental CCC and are associated with myocardial inflammation but do not designate scar tissue, corresponding to regions with metabolically viable myocardium.


Assuntos
Cardiomiopatia Chagásica/fisiopatologia , Circulação Coronária , Animais , Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/patologia , Doença Crônica , Cricetinae , Modelos Animais de Doenças , Feminino , Fluordesoxiglucose F18 , Microvasos/diagnóstico por imagem , Microvasos/fisiopatologia , Imagem de Perfusão do Miocárdio , Miocárdio/patologia , Tomografia por Emissão de Pósitrons , Sístole/fisiologia , Sobrevivência de Tecidos , Disfunção Ventricular Esquerda/fisiopatologia
7.
J Nucl Cardiol ; 25(1): 75-83, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-27381340

RESUMO

BACKGROUND: To investigate the correlation between the extent of myocardial sympathetic denervation and fibrosis and the presence of degrees of severity of ventricular arrhythmias in chronic Chagas cardiomyopathy (CCC). METHODS: Forty-three CCC patients with left ventricular ejection fraction (LVEF) ≥ 35% were divided into three groups: SVT group-presenting Sustained Ventricular Tachycardia (SVT) (n = 15), NSVT group-exhibiting episodes of non-SVT (NSVT) on 24-h Holter monitoring (n = 11), and Control group-exhibiting neither SVT nor episodes of NSVT (n = 17). The patients underwent SPECT imaging for myocardial sympathetic innervation with 123Iodine-MIBG (MIBG) and myocardial perfusion with 99mTc-Sestamibi (MIBI) for the evaluation of regional myocardial fibrosis. RESULTS: The summed rest perfusion scores were similar in the three groups. The summed difference score between MIBG and MPI images, which evaluated the extent of denervated but viable myocardium, was significantly higher in SVT group (20.0 ± 8.0) as compared with the control group (2.0 ± 5.0, P < .0001) and with the NSVT group (11.0 ± 8.0, P < .05). CONCLUSIONS: The occurrence of ventricular arrhythmias of different degrees of severity correlates quantitatively with the extent of cardiac sympathetic denervation, but not with the extent of fibrosis, suggesting that myocardial sympathetic denervation plays a major role in triggering ventricular arrhythmia in CCC.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Cardiomiopatia Chagásica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Simpatectomia , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Ecocardiografia , Eletrocardiografia , Feminino , Fibrose , Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Perfusão , Estudos Prospectivos , Índice de Gravidade de Doença , Sístole , Tecnécio Tc 99m Sestamibi
9.
Biomed Res Int ; 2017: 3820191, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28929112

RESUMO

Right ventricle (RV) is considered a neglected chamber in cardiology and knowledge about its role in cardiac function was mostly focused on ventricular interdependence. However, progress on the understanding of myocardium diseases primarily involving the RV led to a better comprehension of its role in health and disease. In Chagas disease (CD), there is direct evidence from both basic and clinical research of profound structural RV abnormalities. However, clinical detection of these abnormalities is hindered by technical limitations of imaging diagnostic tools. Echocardiography has been a widespread and low-cost option for the study of patients with CD but, when applied to the RV assessment, faces difficulties such as the absence of a geometrical shape to represent this cavity. More recently, the technique has evolved to a focused guided RV imaging and myocardial deformation analysis. Also, cardiac magnetic resonance (CMR) has been introduced as a gold standard method to evaluate RV cavity volumes. CMR advantages include precise quantitative analyses of both LV and RV volumes and its ability to perform myocardium tissue characterization to identify areas of scar and edema. Evolution of these cardiac diagnostic techniques opened a new path to explore the pathophysiology of RV dysfunction in CD.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ecocardiografia , Humanos , Imagem Cinética por Ressonância Magnética
10.
Am J Trop Med Hyg ; 96(5): 1139-1142, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28500812

RESUMO

AbstractChagas disease (CD), with associated conduction abnormalities, is a common indication for pacemaker implantation in Latin America. The prevalence of CD in Latin American immigrants with pacemakers residing in the United States has never been studied. This single-center cross-sectional study included pacemaker patients who were aged 18 years or more with a previous residence in Latin America for at least 6 months. Patients with an implantable cardioverter-defibrillator, cardiac resynchronization therapy, or iatrogenic and/or congenital heart block were excluded. Serological testing for Trypanosoma cruzi was performed at enrollment. A total of 80 patients were enrolled, and CD was diagnosed in six patients (7.5%). Patients with CD were more likely to be from El Salvador (P = 0.001). Other clinical, therapeutic, electrocardiographic, and echocardiographic variables were similar between the CD and non-CD groups. There is a high prevalence of CD among Latin American immigrants with pacemakers in Los Angeles.


Assuntos
Anticorpos Antiprotozoários/sangue , Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/etnologia , Marca-Passo Artificial , Trypanosoma cruzi/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatia Chagásica/parasitologia , Cardiomiopatia Chagásica/cirurgia , Estudos Transversais , El Salvador/etnologia , Eletrocardiografia , Emigrantes e Imigrantes , Feminino , Hispano-Americanos , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Trypanosoma cruzi/imunologia
11.
Clin Nucl Med ; 42(5): e265-e268, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28263213

RESUMO

Uptake of the radiopharmaceutical F-FDG visualized by PET imaging can reflect abnormal myocardial inflammation. When utilized in conjunction with other imaging modalities, such as echocardiography, PET F-FDG imaging can help distinguish between active cardiac sarcoidosis and other etiologies of nonischemic cardiomyopathy. We present a case of a 46-year-old man with nonischemic cardiomyopathy and ventricular tachycardia who underwent an echocardiogram suggestive of cardiac Chagas disease. A subsequent F-FDG PET demonstrated abnormal hypermetabolism. The diagnosis was confirmed by positive serologic examination results.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Fluordesoxiglucose F18/metabolismo , Coração/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/metabolismo , Cardiomiopatia Chagásica/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade
12.
J Am Soc Echocardiogr ; 30(5): 493-502, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28284461

RESUMO

BACKGROUND: Chagas disease leads to biventricular heart failure, usually with prominent systemic congestion. Although echocardiography is widely used in clinical routine, the utility of echocardiographic parameters to detect right ventricular (RV) systolic dysfunction in patients with Chagas disease is unknown. We sought to study the diagnostic value of echocardiography, including speckle-tracking parameters, to distinguish individuals with RV systolic dysfunction from those with normal RV systolic function in Chagas disease using cardiac magnetic resonance (CMR) as the reference method. METHODS: In this cross-sectional study, 63 individuals with Chagas disease underwent echocardiography and CMR evaluations. Conventional echocardiographic parameters for RV functional evaluation were tricuspid annular plane systolic excursion, RV systolic excursion velocity, fractional area change, and RV index of myocardial performance. Strain and strain rate were obtained by two-dimensional speckle-tracking echocardiography and defined as "RV free wall," when based only in segments from RV free wall, or "RV free wall and septum," when segments from both free RV wall and interventricular septum were included. RV systolic dysfunction was defined as RV ejection fraction (RVEF) < 50% by CMR. RESULTS: Mean age was 56 ± 14 years, and 58.7% of the patients were men. RV systolic dysfunction was detected by CMR in 18 (28.6%) individuals. RV free wall strain showed the highest correlation with RVEF by CMR (r = -0.62, P < .001), followed by fractional area change (r = 0.56, P < .001), RV free wall and septum strain (r = -0.54, P < .001), RV free wall and septum strain rate (r = -0.47, P < .001), RV free wall strain rate (r = -0.45, P < .001), and RV systolic excursion velocity (r = 0.30, P = .016). The RV index of myocardial performance and tricuspid annular plane systolic excursion showed a small and not significant correlation with RVEF (r = -0.20, P = .320; r = 0.14; P = .289, respectively). Using predefined cutoffs for RV systolic dysfunction, RV free wall strain (>-22.5% for men and >-23.3% for women) exhibited the highest area under the receiver operating characteristic curve (area under the curve = 0.829) to differentiate the presence from the absence of RV systolic dysfunction in Chagas disease, with a sensitivity and specificity of 67% and 83%, respectively. CONCLUSIONS: RV free wall strain is an appropriate and superior echocardiographic variable for evaluating RV systolic function in Chagas disease, and it should be the method of choice for this purpose.


Assuntos
Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/diagnóstico por imagem , Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume Sistólico
13.
Artigo em Inglês | MEDLINE | ID: mdl-28289020

RESUMO

BACKGROUND: Right ventricular (RV) impairment is postulated to be responsible for prominent systemic congestion in Chagas disease. However, occurrence of primary RV dysfunction in Chagas disease remains controversial. We aimed to study RV systolic function in patients with Chagas disease using cardiac magnetic resonance. METHODS AND RESULTS: This cross-sectional study included 158 individuals with chronic Chagas disease who underwent cardiac magnetic resonance. RV systolic dysfunction was defined as reduced RV ejection fraction based on predefined cutoffs accounting for age and sex. Multivariable logistic regression was used to verify the relationship of RV systolic dysfunction with age, sex, functional class, use of medications for heart failure, atrial fibrillation, and left ventricular systolic dysfunction. Mean age was 54±13 years, 51.2% men. RV systolic dysfunction was identified in 58 (37%) individuals. Although usually associated with reduced left ventricular ejection fraction, isolated RV systolic dysfunction was found in 7 (4.4%) patients, 2 of them in early stages of Chagas disease. Presence of RV dysfunction was not significantly different in patients with indeterminate/digestive form of Chagas disease (35.7%) compared with those with Chagas cardiomyopathy (36.8%) (P=1.000). CONCLUSIONS: In chronic Chagas disease, RV systolic dysfunction is more commonly associated with left ventricular systolic dysfunction, although isolated and early RV dysfunction can also be identified.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatia Chagásica/fisiopatologia , Doença Crônica , Estudos Transversais , Feminino , Fibrose , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Miocárdio/patologia , Valor Preditivo dos Testes , Prognóstico , Sístole , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Esquerda , Função Ventricular Direita
14.
Infect Genet Evol ; 49: 151-156, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28095298

RESUMO

The parasitic protozoan Trypanosoma cruzi, the causative agent of Chagas disease, is widely distributed throughout the Americas, from the southern United States (US) to northern Argentina, and infects at least 6 million people in endemic areas. Much remains unknown about the dynamics of T. cruzi transmission among mammals and triatomine vectors in sylvatic and peridomestic eco-epidemiological cycles, as well as of the risk of transmission to humans in the US. Identification of T. cruzi DTUs among locally-acquired cases is necessary for enhancing our diagnostic and clinical prognostic capacities, as well as to understand parasite transmission cycles. Blood samples from a cohort of 15 confirmed locally-acquired Chagas disease patients from Texas were used for genotyping T. cruzi. Conventional PCR using primers specific for the minicircle variable region of the kinetoplastid DNA (kDNA) and the highly repetitive genomic satellite DNA (satDNA) confirmed the presence of T. cruzi in 12/15 patients. Genotyping was based on the amplification of the intergenic region of the miniexon gene of T. cruzi and sequencing. Sequences were analyzed by BLAST and phylogenetic analysis by Maximum Likelihood method allowed the identification of non-TcI DTUs infection in six patients, which corresponded to DTUs TcII, TcV or TcVI, but not to TcIII or TcIV. Two of these six patients were also infected with a TcI DTU, indicating mixed infections in those individuals. Electrocardiographic abnormalities were seen among patients with single non-TcI and mixed infections of non-TcI and TcI DTUs. Our results indicate a greater diversity of T. cruzi DTUs circulating among autochthonous human Chagas disease cases in the southern US, including for the first time DTUs from the TcII-TcV-TcVI group. Furthermore, the DTUs infecting human patients in the US are capable of causing Chagasic cardiac disease, highlighting the importance of parasite detection in the population.


Assuntos
Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/transmissão , DNA de Cinetoplasto/genética , Insetos Vetores/parasitologia , Filogenia , Triatoma/parasitologia , Trypanosoma cruzi/genética , Animais , Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/parasitologia , Estudos de Coortes , DNA Intergênico/genética , DNA Satélite/genética , Eletrocardiografia , Técnicas de Genotipagem , Humanos , Texas/epidemiologia , Trypanosoma cruzi/classificação
15.
J Echocardiogr ; 15(1): 6-12, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27450558

RESUMO

BACKGROUND: Chagas disease (CD) is highly endemic in Latin America, and has been emerging in developed countries. Early diagnosis of left ventricular (LV) systolic dysfunction, routinely done by echocardiography, is crucial for therapy. Speckle tracking echocardiography allows determination of LV segmental rotations, twist/torsion, and this analysis may disclose an unapparent myocardial contractile deficit in initial stages of CD. Therefore, this study aimed to highlight a possible unapparent myocardial contractile deficit in CD indeterminate form (IF) by a comprehensive torsional mechanics analysis. METHODS: Patients with CDIF diagnosis, initial chagasic cardiomyopathy (CCMP characterized by ECG abnormalities and LVEF > 0.55), and normal controls were prospectively enrolled, and underwent conventional echocardiogram with images acquisition for STE offline analysis. Target parameters were basal and apical rotations, and calculation of twist and torsion. RESULTS: A total of 42 patients were included (CDIF, eight; CCMP, 13; and 21 controls). Chagasic patients had a mean age of 55 years, five (24 %) men, and controls, 50 years, seven (33 %) men. Torsional mechanics analyzes resulted in no significant difference in all parameters studied between groups. Twist in CDIF was 20.8° ± 6.5°; CCMP, 19.0° ± 3.5° and controls, 19.7° ± 3.7° (p = 0.67). Torsion in CDIF was 2.6° ± 0.8°; CCMP, 2.4° ± 0.6° and controls, 2.4° ± 0.5° (p = 0.63). CONCLUSIONS: Patients with Chagas disease have no abnormalities in torsional mechanics during its indeterminate and initial cardiomyopathy stages.


Assuntos
Cardiomiopatia Chagásica/diagnóstico , Ecocardiografia Transesofagiana , Disfunção Ventricular Esquerda/diagnóstico por imagem , Cardiomiopatia Chagásica/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/fisiopatologia
17.
Arq Bras Cardiol ; 107(5): 460-466, 2016 Nov.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27982271

RESUMO

Background:: Chagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score. Methods:: This study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score. Results:: Regarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76). Conclusions:: CMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD. Fundamento:: A doença de Chagas (DC) é importante causa de insuficiência cardíaca e mortalidade, principalmente na América Latina. Este estudo avaliou as características morfológicas e funcionais do coração, assim como a extensão da fibrose miocárdica (FM) em pacientes com DC através de ressonância magnética cardíaca (RMC). O valor prognóstico da FM avaliada por realce tardio miocárdico (RTM) foi comparado àquele do escore de Rassi. Métodos:: Avaliação de 39 pacientes divididos em 2 grupos: grupo 'forma indeterminada' (IND), 28 pacientes assintomáticos; e grupo 'cardiopatia chagásica' (CC), pacientes sintomáticos. Todos os pacientes foram submetidos a RMC com as técnicas de cine-RM e RTM, sendo a quantidade de FM evidenciada ao exame comparada ao escore de Rassi. Resultados:: As análises morfológica e funcional mostraram significativas diferenças entre os 2 grupos (p < 0,001). Houve ainda uma forte correlação entre a extensão da FM e o escore de Rassi (r = 0,76). Conclusões:: A RMC é uma importante técnica para avaliar pacientes com DC, ressaltando as diferenças morfológicas e funcionais em todas as apresentações clínicas. A forte correlação entre o escore de Rassi e a extensão da FM detectada por RMC enfatiza seu papel na estratificação prognóstica de pacientes com DC.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Coração/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Miocárdio/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Fibrose/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco
18.
J Cardiovasc Magn Reson ; 18(1): 88, 2016 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-27890014

RESUMO

BACKGROUND: Since a male-related higher cardiovascular morbidity and mortality in patients with Chagas' heart disease has been reported, we aimed to investigate gender differences in myocardial damage assessed by cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: Retrospectively, 62 seropositive Chagas' heart disease patients referred to CMR (1.5 T) and with low probability of having significant coronary artery disease were included in this analysis. Amongst both sexes, there was a strong negative correlation between LV ejection fraction and myocardial fibrosis (male r = 0.64, female r = 0.73, both P < 0.001), with males showing significantly greater myocardial fibrosis (P = 0.002) and lower LV ejection fraction (P < 0.001) than females. After adjustment for potential confounders, gender remained associated with myocardial dysfunction, and 53% of the effect was mediated by myocardial fibrosis (P for mediation = 0.004). Also, the transmural pattern was more prevalent among male patients (23.7 vs. 9.9%, P < 0.001) as well as the myocardial heterogeneity or gray zone (2.2 vs. 1.3 g, P = 0.003). CONCLUSIONS: We observed gender-related differences in myocardial damage assessed by CMR in patients with Chagas' heart disease. As myocardial fibrosis and myocardial dysfunction are associated to cardiovascular outcomes, our findings might help to understand the poorer prognosis observed in males in Chagas' disease.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Adulto , Idoso , Cardiomiopatia Chagásica/patologia , Cardiomiopatia Chagásica/fisiopatologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Feminino , Fibrose , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Volume Sistólico , Função Ventricular Esquerda , Remodelação Ventricular
19.
Tohoku J Exp Med ; 240(3): 243-249, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27890871

RESUMO

Chagas disease is a parasitic infection mainly found in Latin America; it is transmitted by a triatomine, also known as assassin bug or kissing bug. In humans, the parasite causes mostly cardiac disorders. Two-thirds of the Mexican territory are regarded as risk areas for vector transmission of Trypanosoma cruzi, the causal agent. The parasite can be found as a blood-borne trypomastigote or as an intracellular amastigote. The progression and severity of lesions could be due to frequent reinfections or to infection by highly virulent strains. A total of 3,327 individuals younger than 18 years old, living in risk areas for this disease in the rural setting of the States of Queretaro, San Luis Potosi, and Veracruz, underwent a seroepidemiological study. Among them, 37 subjects were seropositive for T. cruzi, and were studied to look for signs of cardiac pathology, which has only been reported in adults. A clinical record was prepared for all included individuals, and electrocardiography (ECG) and echocardiography (ECHO) studies were performed; 25 cases showed lesions compatible with the onset of Chagas cardiomyopathy. The other 12 patients showed either normal ECG and ECHO data or showed abnormal parameters that were not regarded as significant. Lesions found in the onset of Chagas cardiomyopathy in children are herein reported, along with 14 cases of cardiac pathology compatible with Chagas disease. Our results indicate that patients younger than 18 years can show a cardiac pathology similar to that observed in adults.


Assuntos
Cardiomiopatia Chagásica/epidemiologia , Adolescente , Cardiomiopatia Chagásica/diagnóstico por imagem , Criança , Pré-Escolar , Ecocardiografia , Eletrocardiografia , Feminino , Geografia , Humanos , Masculino , México/epidemiologia
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