Cerebral infarction in autopsies of chagasic patients with heart failure

Aras, Roque; Matta, José Alberto Martins da; Mota, Gildo; Gomes, Irênio; Melo, Aílton

doi:10.1590/s0066-782x2003001200008

Cited by 38 publications

(26 citation statements)

References 10 publications

(9 reference statements)

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“…A relevant datum found in our cases in relation to the impact on the patients' quality of life, and coinciding with autopsy fi ndings, was the history of strokes (19%) in Chagas patients that can be justifi ed by the high incidence of embolisms with this cardiopathy 22 .…”

Section: Discussionsupporting

confidence: 75%

Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas

Braga¹,

Reis²,

Aras³

et al. 2006

Arq. Bras. Cardiol.

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OBJECTIVEDescribe the clinical and therapeutic characteristics of patients with heart failure (HF) secondary to chronic chagasic cardiomyopathy and evaluate if these characteristics are different from those found in other etiologies. METHODS RESULTSThree hundred and fi fty six patients diagnosed with HF were included in the study. Chagasic cardiomyopathy was the most common etiology (48% of the cases). Other etiologies included hypertensive cardiomyopathy in 19% of the patients, idiopathic dilated in 11% and ischemic in 9%. Patients with HF secondary to chagasic cardiomyopathy were more frequently from non-white ethnic groups (88 vs. 75%; p = 0.002), had a family history of Chagas disease (57 vs. 21%; p = 0.001), had the disease for a longer length of time (71 vs. 56 months; p = 0.034), had lower levels of education (4.4 ± 4.1 vs. 5.7 ± 4.2 years of study; p = 0.004), had a lower heart rate (69 ± 12 vs. 73 ± 13; p = 0.03) and a lower systolic blood pressure (121 ± 25 vs. 129 ± 28 mmHg; p = 0.006). There was also a higher incidence of the use of amiodarone (22 vs. 13%; p = 0.036) and artifi cial pacemakers (15 vs. 1%; p = 0.001). There was a lower usage of beta-blockers (39 vs. 59%; p = 0.001). CONCLUSIONIn this sample of HF outpatients, in a state with a high prevalence of Chagas disease, chagasic cardiomyopathy was the most common etiology and they presented some unique clinical and therapeutic characteristics in comparison to other heart failure patients. KEY WORDSChagasic cardiomyopathy, heart failure, epidemiology.

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Section: Discussionsupporting

confidence: 75%

Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas

Braga¹,

Reis²,

Aras³

et al. 2006

Arq. Bras. Cardiol.

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“…A gross finding frequently found for patients with chagasic cardiomyopathy is cerebral infarction due to a dislodged thrombus from the left ventricle (23). Chagasic cardiomyopathy-associated heart failure occurs in a mean period of 7 months to 2 years.…”

Section: Clinical and Pathological Presentations Of Chagas' Diseasementioning

confidence: 99%

Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

et al. 2011

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SUMMARY Acute Trypanosoma cruzi infections can be asymptomatic, but chronically infected individuals can die of Chagas' disease. The transfer of the parasite mitochondrial kinetoplast DNA (kDNA) minicircle to the genome of chagasic patients can explain the pathogenesis of the disease; in cases of Chagas' disease with evident cardiomyopathy, the kDNA minicircles integrate mainly into retrotransposons at several chromosomes, but the minicircles are also detected in coding regions of genes that regulate cell growth, differentiation, and immune responses. An accurate evaluation of the role played by the genotype alterations in the autoimmune rejection of self-tissues in Chagas' disease is achieved with the cross-kingdom chicken model system, which is refractory to T. cruzi infections. The inoculation of T. cruzi into embryonated eggs prior to incubation generates parasite-free chicks, which retain the kDNA minicircle sequence mainly in the macrochromosome coding genes. Crossbreeding transfers the kDNA mutations to the chicken progeny. The kDNA-mutated chickens develop severe cardiomyopathy in adult life and die of heart failure. The phenotyping of the lesions revealed that cytotoxic CD45, CD8 + γδ, and CD8α + T lymphocytes carry out the rejection of the chicken heart. These results suggest that the inflammatory cardiomyopathy of Chagas' disease is a genetically driven autoimmune disease.

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“…Several risk factors, such as heart failure, mural thrombi, ventricular apical aneurysm, hypertension and cardiac arrhythmias have been shown to be associated with stroke in patients with Chagas' disease 19,21 . In a study based on autopsies performed in a reference hospital in the State of Bahia between 1956 and 2001, cerebral infarction was reported in 17.5% of autopsies of chagasic patients with heart failure, and complications were associated with death in 52% of cases 16 .…”

Section: Martins-melo Fr Et Al -Causes Of Death Related To Chagas Dismentioning

confidence: 99%

“…The importance of hypertensive disease and ischemic heart disease as contributing causes was also evident, similarly to cerebrovascular diseases. This association with Chagas' disease has concerned some investigators previsouly [16][17][18][19][20] . …”

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confidence: 99%

Multiple causes of death related to Chagas' disease in Brazil, 1999 to 2007

Martins-Melo

Ramos

Alencar

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction:Chagas' disease is a major public health problem in Brazil and needs extensive and reliable information to support consistent prevention and control actions. This study describes the most common causes of death associated with deaths related to Chagas' disease (underlying or associated cause of death). Methods: Mortality data were obtained from the Mortality Information System of the Ministry of Health (approximately 9 million deaths). We analyzed all deaths that occurred in Brazil between 1999 and 2007, where Chagas' disease was mentioned on the death certificate as underlying or associated cause (multiple causes of death). Results: There was a total of 53,930 deaths related to Chagas' disease, 44,543 (82.6%) as underlying cause and 9,387 (17.4%) as associated cause. The main diseases and conditions associated with death by Chagas' disease as underlying cause included direct complications of cardiac involvement, such as conduction disorders/arrhythmias (41.4%) and heart failure (37.7%). Cerebrovascular disease (13.2%), ischemic heart disease (13.2%) and hypertensive diseases (9.3%) were the main underlying causes of deaths in which Chagas' disease was identified as an associated cause. Conclusions: Cardiovascular diseases were often associated with deaths related to Chagas' disease. Information from multiple causes of death recorded on death certificates allows reconstruction of the natural history of Chagas' disease and suggests preventive and therapeutic potential measures more adequate and specifics.Keywords: Chagas' disease. Mortality. Underlying cause of death. Multiple causes of death. Epidemiology. Brazil.The World Health Organization (WHO) recommends mortality statistics to be presented by the underlying cause of death. This is defined as the disease or injury, which initiated the cascade of events leading directly to death, or the circumstances of accident or violence that produced fatal injury 1 . However, especially for infectious and parasitic diseases, there is a need for more comprehensive information on fatal events. Additionally, there is a clear relevance to consider all causes of death recorded on death certificates. These include in addition to the underlying causes of death the associated causes that increase the risk of complications, and other contributing causes not directly related to the process that led to death. These three groups together are called multiple causes of death 2,3 .In Brazil, with significant reduction of vector and blood-borne transmission, the number of cases of acute form of Chagas' disease has been drastically reduced in most endemic areas 4 . In addition, both increased knowledge about the natural history of disease and better effectiveness of clinical and surgical interventions, led to the reduction of specific mortality and increased survival of infected individuals 5 . Recent estimates amount to 2 to 3 million individuals infected with the causing agent Trypanosoma cruzi in Brazil [6][7][8] . A large proportion of these cases occurred in o...

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Cerebral infarction in autopsies of chagasic patients with heart failure

Abstract: Cerebral infarction has been a frequent finding in autopsies of chagasic patients with heart failure, and it has been an important cause of death in our region. The presence of cerebral infarction and its complications have been associated with death in 52% of the cases studied.

Cited by 38 publications

References 10 publications

Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas

Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas

Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

Multiple causes of death related to Chagas' disease in Brazil, 1999 to 2007

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