Electrocardiogram in Chagas disease

Brito, Bruno Oliveira de Figueiredo; Ribeiro, Antônio Luiz Pinho

doi:10.1590/0037-8682-0184-2018

Cited by 26 publications

(22 citation statements)

References 48 publications

(67 reference statements)

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“…The most frequent ECG change found in those who progressed to CHD in our study was IVCD, followed by primary ST-T wave changes, and ventricular arrhythmias. This finding corroborates several studies in which the same ECG changes were the most frequently found in CHD [39,40]. Regarding progression to CHD, other studies described primary ST-T wave changes and ICD as the most frequent findings [9,21].…”

Section: Discussionsupporting

confidence: 90%

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

Hasslocher‐Moreno¹,

Xavier²,

Saraiva³

et al. 2020

TropicalMed

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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 ± 48 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.

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Section: Discussionsupporting

confidence: 90%

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

Hasslocher‐Moreno¹,

Xavier²,

Saraiva³

et al. 2020

TropicalMed

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“…To ensure that our infection model properly reflects Chagas disease symptoms, we performed electrocardiography and histological analyses of the infected hearts (Fig 1A). We found that PLOS NEGLECTED TROPICAL DISEASES mice infected with T. cruzi presented heart arrhythmias (Fig 1B and 1C), a lower heart rate (Fig 1D ) and AV block (Fig 1C and 1E), which mimics human chagasic hearts [35] and are in accordance with previous mouse models of chronic T. cruzi infection using different strains of the parasite [36]. The extended QT interval observed in previous mouse infections [36] was also captured in our model (Fig 1F).…”

Section: Mouse Model Of Chagas Diseasementioning

confidence: 77%

Molecular dissection of Chagas induced cardiomyopathy reveals central disease associated and druggable signaling pathways

et al. 2020

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Chagas disease, the clinical presentation of T. cruzi infection, is a major human health concern. While the acute phase of Chagas disease is typically asymptomatic and self-resolving, chronically infected individuals suffer numerous sequelae later in life. Cardiomyopathies in particular are the most severe consequence of chronic Chagas disease and cannot be reversed solely by parasite load reduction. To prioritize new therapeutic targets, we unbiasedly interrogated the host signaling events in heart tissues isolated from a Chagas disease mouse model using quantitative, multiplexed proteomics. We defined the host response to infection at both the proteome and phospho-proteome levels. The proteome showed an increase in the immune response and a strong repression of several mitochondrial proteins. Complementing the proteome studies, the phospho-proteomic survey found an abundance of phospho-site alterations in plasma membrane and cytoskeletal proteins. Bioinformatic analysis of kinase activity provided substantial evidence for the activation of NDRG2 and JNK/p38 kinases during Chagas disease. A significant activation of DYRK2 and AMPKA2 and the inhibition of casein family kinases were also predicted. We concluded our analyses by linking the diseased heart proteome profile to known therapeutic interventions, uncovering a potential to target mitochondrial proteins, secreted immune effectors and core kinases for the treatment of chronic Chagas disease. Together, this study provides molecular insight into host proteome and phospho-proteome responses to T. cruzi infection in the heart for the first time, highlighting pathways that can be further validated for functional contributions to disease and suitability as drug targets.

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“…Furthermore, CD is associated with particular ECG patterns, especially the combination of RBBB and LAFB. The prevalence of ECG alterations is much higher among individuals with CD than seronegative individuals, and within T cruzi -positive individuals, is associated with age and male gender [30]. The development of a range of ECG abnormalities, including RBBB, LAFB, and first-degree atrioventricular block, has been reported among CD patients with a normal baseline ECG [6, 15, 31].…”

Section: Discussionmentioning

confidence: 99%

Progression of Baseline Electrocardiogram Abnormalities in Chagas Patients Undergoing Antitrypanosomal Treatment

Soverow

Hernández

Sanchez

et al. 2019

Open Forum Infectious Diseases

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Background The objective of the study was to better understand the impact of antitrypanosomal treatment on the evolution of Chagas-related, prognostically important electrocardiogram (ECG) abnormalities. Methods Initial and posttreatment ECGs were obtained in a prospective cohort of Chagas patients treated with nifurtimox or benznidazole and compared to an untreated cohort. Electrocardiogram disease progression was compared in those with and without baseline abnormalities pre- and posttherapy. Results Fifty-nine patients were recruited in the treatment arm and followed for an average of 3.9 years. There were no differences between ECG groups with regards to follow-up, age, baseline ejection fraction, or therapy. In the treated cohort, 0 of 30 patients with normal ECGs developed an abnormal ECG compared with 7 of 29 patients with baseline ECG abnormalities who developed new ECG abnormalities (P = .005). In an untreated cohort of 30 patients, 3 of 7 with normal ECGs developed an abnormality compared with 14 of 23 patients with baseline abnormalities (P = .67). Untreated patients had a higher likelihood of developing new EKG abnormalities (56.7% vs 11.9%, P < .001) despite shorter follow-up, and in a multivariate analysis adjusting for baseline EKG status across both treated and untreated cohorts, treated patients were still less likely to have progression of their EKG disease (odds ratio = 0.13, P < .001). The corrected QT (QTc) interval was not significantly affected by either study medication (415 vs 421 ms, initial vs posttreatment QTc; P = .06). Conclusions Over an average follow-up of 3.9 years, treated patients with normal baseline ECGs did not have significant changes during a course of treatment; however, those with baseline abnormal ECGs had significant progression of their conduction system disease despite treatment, and those without treatment also experienced a progression of ECG disease. These preliminary results suggest that Chagas patients with normal ejection fraction and normal ECG may benefit the most from antitrypanosomal treatment.

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Electrocardiogram in Chagas disease

Cited by 26 publications

References 48 publications

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

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

Molecular dissection of Chagas induced cardiomyopathy reveals central disease associated and druggable signaling pathways

Progression of Baseline Electrocardiogram Abnormalities in Chagas Patients Undergoing Antitrypanosomal Treatment

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