Doença de Chagas em Virgem da Lapa, Minas Gerais, Brasil. IV. Aspectos clínicos e epidemiológicos do aneurisma ventricular esquerdo

Abstract

The study aimed at the evaluation of the clinical and epidemiological characteristics of the aneurysm found in the left ventricle in chronic Chagas' disease patients. Three hundred, eighty eight people (298 chagasic patients and 90 randomly selected healthy individuals) were submitted to echocardiography. The ventricular function was assessed in the M mode by calculating the fraction of ejection, and in the bidimensional mode by analyzing he global systolic function. Segmental contractility was evaluated according to the method described by American Society of Echocardiography. Aneurysm of the left ventricle was diagnosed in 58 (18.8%) patients, all from the chagasic population. From these, 38 (12.7%) were found in the apical segment; 10 (3.4%) in the interventricular septum; and 2 (0.7%) each in the posterior wall; the inferior wall; apico-septal; and inferior-posterior. We could not observe any significant difference for the aneurysm frequencies in relation to age group, gender and race, and no association between aneurysm and arterial hypertension could be made. Of the 56 individuals presenting aneurysm, 55 (98.2%) were symptomatic with predominant palpitations; 53 (94.6%) showed an aberrant ECG with predominant ventricular extra-systoles followed by changes in conduction; and 34 (60.%) showed an impairment of the ventricular function, regardless of the affected segment. In view of these results we consider the apical aneurysm of the left ventricle as a marker of Chagas' disease and as an indicator of high morbidity of the human T. cruzi infection in Virgem da Lapa.

Selenium Treatment and Chagasic Cardiopathy (STCC): study protocol for a double-blind randomized controlled trial

“…In this estimate calculation, we considered an α error of 0.05, a β error of 0.20 and a difference in progression risk of 50%. The calculation assumed a progression rate scenario for cardiopathy based on findings for LVEF decline in a previous cohort study conducted in Brazil (Virgem da Lapa, State of Minas Gerais) [ 44 ]. See Table 1 for details.…”

A protocol update for the Selenium Treatment and Chagasic Cardiomyopathy (STCC) trial

“…STCC trial recruitment started in 2014 and aimed to include 130 patients to be followed for 5 years. The sample size was calculated based on the rate of disease progression described in Virgem da Lapa [ 7 ], which is reproduced in our hospital urban cohort [ 8 ] and obviously required a larger sample size.…”

Geographical origin of chronic Chagas disease patients in Brazil impacts the performance of commercial tests for anti-T. cruzi IgG

“…Ethical considerations for the use of human serum - All patient serum samples used in the present study were previously obtained from individuals who participated in sectional and longitudinal epidemiological studies carried out in the referred areas at intervals of 9 to 13 years. 18 , 19 , 20 All sample collections and experiment use were pre-approved by the ethical committee of the Oswaldo Cruz Institute of Fiocruz (CEP 289/05 and Protocol number 0019.0.009.000-07).…”

“…It also included access to clinical information and a diagnosis of each sera as determined through two independent assays, indirect immunofluorescence and ELISA. The conclusions of these studies showed significant regional differences in the morbidity of Chagas disease with a higher prevalence and severity of cardiac and digestive forms among patients from PI and MG that was notably lower among patients from AM and MS. 16 , 18 , 19 , 20 , 23 , 24 , 25 …”

“…The TESA test is considered a complementary test for specificity that consists of the fractionation and separation of antigens excreted and secreted from trypomastigote cultures whose results are interpreted based on a visual evaluation. 18 , 19 , 20 Here, the specificity of the commercial tests was considered good based on the analysis of the non-reactive samples. All of the samples from AM and MS that were initially considered non-reactive remained non-reactive and only one from PI showed weak reactivity by the commercial tests.…”