Sudden death in patients with Chagas disease

Lopes, Edison Reis

doi:10.1590/s0074-02761999000700061

Cited by 22 publications

(18 citation statements)

References 8 publications

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“…Sudden death in Chagas' disease is almost always due to ventricular fibrillation, generally preceded by sustained ventricular tachycardia. 24 Reentry constitutes the main electrophysiologic mechanism involved in the chain of events leading to these life-threatening ventricular tachyarrhythmias. The risk of this terminal event is conditioned by the presence of structural myocardial abnormalities and modulated by functional variations.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of QT Interval Parameters for Mortality Risk Stratification in Chagas’ Disease

et al. 2003

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Background-QT interval parameters are potential prognostic markers of arrhythmogenicity risk and cardiovascular mortality and have never been evaluated in Chagas' disease. Methods and Results-Outpatients (738) in the chronic phase of Chagas' disease were enrolled in a long-term follow-up study. Maximal heart rate-corrected QT (QTc) and T-wave peak-to-end (TpTe) intervals and QRS, QT, JT, QTapex, and TpTe dispersions and variation coefficients were measured manually and calculated from 12-lead ECGs obtained on admission. Clinical, radiological, and 2-dimensional echocardiographic data were also recorded. Primary end points were all-cause, Chagas' disease-related, and sudden cardiac mortalities. During a follow-up of 58Ϯ39 months, 62 patients died, 54 of Chagas' disease-related causes and 40 suddenly. Multivariate Cox survival analysis revealed that the QT-interval dispersion (QTd) (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.63; PϽ0.001, for 10-ms increments) and left ventricular (LV) end-systolic dimension (hazard ratio, 1.36; 95% confidence interval, 1.21 to 1.53; PϽ0.001, for 5-mm increments) were the strongest independent predictors for all end points. The maximum QTc interval (QTcmax) could substitute for QTd with a worse predictive performance. Other predictors were heart rate, presence of pathological Q waves, frequent premature ventricular contractions (PVCs), and isolated left anterior fascicular block (LAFB) on the ECGs. Kaplan-Meier survival curves demonstrated that a QTd Ն65 ms or a QTcmax Ն465 ms 1/2 discriminated the 2 groups with significantly different prognoses. Conclusions-Electrocardiographic QTd and echocardiographic LV end-systolic dimension were the most important mortality predictors in patients with Chagas' disease. Heart rate, the presence on ECG of pathological Q waves, frequent PVCs, and isolated LAFB refined the mortality risk stratification. (Circulation. 2003;108:305-312.)

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of QT Interval Parameters for Mortality Risk Stratification in Chagas’ Disease

et al. 2003

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“…However, 20 to 30% of those infected will suffer from irreversible damage to the heart, esophagus, or colon, decades after acquisition of the parasite (5,40). Heart failure is a common cause of sudden death early in life (26). In spite of intense attempts to eradicate the insect vector in past years, the disease still affects over 8 million persons in Latin America, and 75 million people are at risk of infection (40).…”

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confidence: 99%

Highly Effective Serodiagnosis for Chagas' Disease

Hernàndez

Heimann

Riera

et al. 2010

Clin Vaccine Immunol

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Many proteins of Trypanosoma cruzi, the causative agent of Chagas' disease, contain characteristic arrays of highly repetitive immunogenic amino acid motifs. Diagnostic tests using these motifs in monomeric or dimeric form have proven to provide markedly improved specificity compared to conventional tests based on crude parasite extracts. However, in many cases the available tests still suffer from limited sensitivity. In this study we produced stable synthetic genes with maximal codon variability for the four diagnostic antigens, B13, CRA, TcD, and TcE, each containing between three and nine identical amino acid repeats. These genes were combined by linker sequences encoding short proline-rich peptides, giving rise to a 24-kDa fusion protein which was used as a novel diagnostic antigen in an enzyme-linked immunosorbent assay setup. Validation of the assay with a large number of well-characterized patient sera from Bolivia and Brazil revealed excellent diagnostic performance. The high sensitivity of the new test may allow future studies to use blood collected by finger prick and dried on filter paper, thus dramatically reducing the costs and effort for the detection of T. cruzi infection.

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“…The following elements may indicate increased risk for sudden death: frequent complaint of syncope or presyncope, presence of complex ventricular arrhythmias on dynamic or exercise electrocardiography, complex extrasystoles not responding to treatment, nontreated atrioventricular blocks, and atrial fibrillation on electrocardiography. Age may also be considered an aggravating risk factor, because sudden death is 5 times more prevalent in the age bracket from 40 to 50 years than in that from 0 to 19 years, particularly among male patients who have alterations in ventricular repolarization, right branch block, and electrically inactive areas 18,19 . Ventricular arrhythmias are particularly common during or right after exercise, and they occur in most patients undergoing exercise testing 20 .…”

Section: Discussionmentioning

confidence: 99%

A sixty-four-year-old woman with Chagas' disease, who underwent implantation of a permanent cardiac pacemaker and evolved with rapidly progressive heart failure

Medeiros¹,

Benvenuti²,

Costa³

2001

Arq. Bras. Cardiol.

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A 64-year-old female patient sought medical assistance at our hospital due to dyspnea on light exertion and even at rest.The patient had been experiencing dyspnea on strenuous exertion since the age of 52 years, which progressed in 10 years to dyspnea on light exertion and even orthopnea.On physical examination (9/1/97), her pulse was regular, her heart rate was 56bpm, and her blood pressure was 140/170mmHg. Her lung examination was within the normal range. The cardiac ictus could be felt on the left 6 th intercostal space over the length of 2 fingertips. A systolic thrill was palpated on the 6 th intercostal space. The cardiac sounds were normal. A systolic cardiac murmur (++/4) was heard on the mitral area and a diastolic cardiac murmur was heard on the aortic area. The abdominal examination was within the normal range and no edema of the lower limbs was observed.The chest X-ray showed enlargement of the cardiac silhouette (++++/4) and normal pulmonary fields.Electrocardiography (8/27/97) showed an ectopic atrial rhythm, a P-R interval of 0.12 s, an initial disturbance of ventricular depolarization (initial QRS blurring in II, III, aVF, and V2), disorder of heart conduction of the anterosuperior left bundle-branch and the right branch, and alterations in ventricular repolarization ( fig. 1).The laboratory tests (8/27/97) were as follows: hemoglobin, 13.6g/dL; hematocrit, 39%; serum creatinine, 0.7mg/ dL; serum sodium, 141mEq/L; and serum potassium, 4.5mEq/L. The serum tests for Chagas' disease were positive.The diagnosis of heart failure due to Chagas' cardiomyopathy was established and the patient was prescribed 37.5mg of captopril and 25mg of hydrochlorothiazide daily.Echocardiography (12/18/97) showed diffuse hypokinesia of the left ventricle, ectasia of the aortic root, moderate regurgitation of the aortic and mitral valves, and pulmonary hypertension. The measurements are shown in table I.Chest tomography (3/31/99) revealed ectasia of the aortic root (52.66mm) and the following preserved diameters: ascending aorta (39.79mm), aortic arch (31.12mm and 25.76mm), descending aorta (26.27mm), and thoracoabdominal transition (21.4mm).The symptoms subsided, as did the dyspnea on moderate exertion. After 10 months, however, the dyspnea became more severe, being triggered on minimum exertion, and even orthopnea occurred (Sept '98). The patient then sought medical care, and an irregular cardiac rhythm was observed.Electrocardiography (9/3/98) showed an irregular rhythm of the atrial pacemaker with junctional escapes and ventricular premature depolarizations, QRS duration of 0.12 s, anterosuperior left bundle-branch block and block of the right branch ( fig. 2).Two months later, the patient required hospitalization (from 11/17/98 to 12/10/98) for control of heart failure.On physical examination (11/17/98), the patient had an irregular pulse, heart rate of 56 bpm, blood pressure of 110/ 80mmHg, crepitant rales in the base of her thorax, irregular cardiac rhythm due to frequent premature depolarizations, and a systolic...

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Sudden death in patients with Chagas disease

Cited by 22 publications

References 8 publications

Prognostic Value of QT Interval Parameters for Mortality Risk Stratification in Chagas’ Disease

Prognostic Value of QT Interval Parameters for Mortality Risk Stratification in Chagas’ Disease

Highly Effective Serodiagnosis for Chagas' Disease

A sixty-four-year-old woman with Chagas' disease, who underwent implantation of a permanent cardiac pacemaker and evolved with rapidly progressive heart failure

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