Case-control study of factors associated with chronic Chagas heart disease in patients over 50 years of age

Silva, Silvana de Araújo; Gontijo, Eliane Dias; Amaral, Carlos Faria Santos

doi:10.1590/s0074-02762007000700010

Cited by 12 publications

(7 citation statements)

References 9 publications

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“…Resorting to univariate analysis, this paper – as did other important longitudinal studies – has revealed the following as statistically significant variables found to be predictive factors for CCC worsening as an outcome: male gender 12 , 14 , age > 50 years 20 , 25 , 28 ; CTR ≥ 0.50 13 , 14 , 22 , 25 ; time of use of digitalis 30 , identification of ventricular arrhythmias in the ET 24 categorized from Lown 1 to 4; Holter monitoring showing pauses equal to or greater than two seconds, and ventricular arrhythmia – sustained and non-sustained VT 22 , 24 . A statistically significant finding – time taking cardiovascular medication – may be related to more severe cases of CCC (patients who needs treatment) as well as the variable "time of use of digitalis".…”

Section: Discussionmentioning

confidence: 66%

Predictive Factors for the Progression of Chronic Chagas Cardiomyopathy in Patients Without Left Ventricular Dysfunction

Silva

Gontijo

Dias

et al. 2015

Rev. Inst. Med. trop. S. Paulo

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The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC) is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox’s univariate model) and multivariate (Cox regression model) analysis. Patients were followed from two to 20 years (mean: 8.2). Their mean age was 44.8 years (20-77). Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01). The predictors for CCC progression in the final regression model were male gender (HR = 2.81), Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02) increased cardiothoracic ratio (HR = 7.87) and time of use of digitalis (HR = 1.41). Patients with multiple predictive factors require stricter follow-up and treatment.

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Section: Discussionmentioning

confidence: 66%

Predictive Factors for the Progression of Chronic Chagas Cardiomyopathy in Patients Without Left Ventricular Dysfunction

Silva

Gontijo

Dias

et al. 2015

Rev. Inst. Med. trop. S. Paulo

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“…21 It was surprising that older age at baseline and length of exposure to T cruzi did not predict incident disease because previous studies have implicated age as a risk factor. 7,22 Our epidemiological data and T cruzi eradication campaigns over the last 20 years in Brazil suggest that infection occurred in most subjects during childhood or young adulthood. 23 Thus, the lack of an age association suggests that variation in host genetics or immunology, rather than duration of infection, is more important in determining disease risk.…”

Section: Discussionmentioning

confidence: 84%

Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic Trypanosoma cruzi –Seropositive Former Blood Donors

et al. 2013

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Background Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi–infected persons. Methods and Results We performed a retrospective cohort study among initially healthy blood donors with an index T cruzi–seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of São Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499 T cruzi seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488 T cruzi seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to T cruzi infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction <50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (P<0.01) with male sex, a history of abnormal ECG, and the presence of an S3 heart sound. Conclusions There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic T cruzi–seropositive blood donors, although disease was mild at diagnosis.

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“…SILVA et al 58 have shown that the age variable acts as a risk factor associated with the development of Chagas heart disease. They observed that patients over 60 years old were three times more likely to have heart disease when compared to those aged 50-59 (OR = 2.89, 95% CI = 1.09-7.61).…”

Section: Discussionmentioning

confidence: 99%

Clinical and Epidemiological Profile of Elderly Patients With Chagas Disease Followed Between 2005-2013 by Pharmaceutical Care Service in Ceará State, Northeastern Brazil

Pereira

Freitas

Fidalgo

et al. 2015

Rev. Inst. Med. trop. S. Paulo

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By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

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Case-control study of factors associated with chronic Chagas heart disease in patients over 50 years of age

Abstract: A case-control study on chronic Chagas heart disease (CCHD)

Cited by 12 publications

References 9 publications

Predictive Factors for the Progression of Chronic Chagas Cardiomyopathy in Patients Without Left Ventricular Dysfunction

Predictive Factors for the Progression of Chronic Chagas Cardiomyopathy in Patients Without Left Ventricular Dysfunction

Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic Trypanosoma cruzi –Seropositive Former Blood Donors

Clinical and Epidemiological Profile of Elderly Patients With Chagas Disease Followed Between 2005-2013 by Pharmaceutical Care Service in Ceará State, Northeastern Brazil

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