Chronic Chagas Cardiomyopathy Patients and Resynchronization Therapy: a Survival Analysis

Menezes, Antônio da Silva; Lopes, Cynthia Caetano; Cavalcante, Patrícia Freire; Martins, Edésio

doi:10.21470/1678-9741-2017-0134

Cited by 7 publications

(4 citation statements)

References 33 publications

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“…congolense or T . b brucei were analyzed by Kaplan-Meier method to determine survival distribution [31]function with log-rank (Mantel-Cox) and Gehan-Breslow-Wilcoxon test[32] to provide insight on effect of route of trypanosome infection on survivorship. All analyses were conducted using GraphPad Prism version 7.00 for Mac (GraphPad Software, La Jolla California USA).…”

Section: Methodsmentioning

confidence: 99%

Route of inoculation influences Trypanosoma congolense and Trypanosoma brucei brucei virulence in Swiss white mice

et al. 2019

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Experiments on infections caused by trypanosomes are widely performed in Swiss white mice through various inoculation routes. To better understand the effect of route of trypanosome inoculation on disease outcomes in this model, we characterised the virulence of two isolates, Trypanosoma bruce i KETRI 2710 and T . congolense KETRI 2765 in Swiss white mice. For each of the isolates, five routes of parasite inoculation, namely intraperitoneal (IP), subcutaneous (SC), intramuscular (IM) intradermal (ID) and intravenous (IV) were compared using groups (n = 6) of mice, with each mouse receiving 1x10 4 trypanosomes. We subsequently assessed impact of the routes on disease indices that included pre-patent period (PP), parasitaemia levels, Packed Cell Volume (PCV), bodyweight changes and survival time. Pre-patent period for IP inoculated mice was a mean ± SE of 3.8 ± 0.2 and 6.5 ± 0.0 for the T brucei and T . congolense isolates respectively; the PP for mice groups inoculated using other routes were not significantly different(p> 0.05) irrespective of route of inoculation and species of trypanosomes. With ID and IP routes, parasitaemia was significantly higher in T . brucei and significantly lower in T . congolense infected mice and the progression to peak parasitaemia routes showed no significant different between the routes of either species of trypanosome. The IM and ID routes in T . congolense inoculations, and IP and IV in T . b . brucei induced the fastest and slowest parasitaemia progressions respectively. There were significant differences in rates of reduction of PCV with time post infection in mice infected by the two species and which was more pronounced in sc and ip injected mice. No significant differences in mice body weight changes and survivorship was observed between the routes of inoculation. Inoculation route therefore appears to be a critical determinant of pathogenicity of Trypanosoma congolense and Trypanosoma brucei brucei in murine mouse model of African trypanosomiasis.

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Section: Methodsmentioning

confidence: 99%

Route of inoculation influences Trypanosoma congolense and Trypanosoma brucei brucei virulence in Swiss white mice

et al. 2019

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“…[100] CRT could be used in the treatment of patients with severe HF and left bundle branch block but there is scarce evidence to support resynchronisation therapy for patients with ChCM and right bundle branch block or its combination with left anterior fascicular block, where experience is not conclusive. [101,102]…”

Section: Invasive Treatment Of Cardiovascular Chagas Diseasementioning

confidence: 99%

Chagas Disease and Heart Failure: An Expanding Issue Worldwide

Martínez

Perna

Perrone³

et al. 2019

Eur Cardiol

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Chagas disease, originally a South American endemic health problem, is expanding worldwide because of people migration. Its main impact is on the cardiovascular system, producing myocardial damage that frequently results in heart failure. Pathogenic pathways are mainly related to inmunoinflamatory reactions in the myocardium and, less frequently, in the gastrointestinal tract. The heart usually shows fibrosis, producing dilatation and damage of the electrogenic cardiac system. These changes result in cardiomyopathy with heart failure and frequent cardiac arrhythmias and heart blocks. Diagnosis of the disease must include a lab test to detect the parasite or its immune reactions and the usual techniques to evaluate cardiac function. Therapeutic management of Chagas heart failure does not differ significantly from the most common treatment for dilated cardiomyopathy, with special focus on arrhythmias and several degrees of heart block. Heart transplantation is reserved for end-stage cases. Major international scientific organisations are delivering recommendations for prevention and early diagnosis. This article provides an analysis of epidemiology, prevention, treatment and the relationship between Chagas disease and heart failure.

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“…Among patients infected with T. Cruzi, only 20% to 30% develop Chronic Chagasic Cardiomyopathy (CCC), which is the most serious condition of Chagas disease and usually occurs decades after the initial infection 5 . Chagas disease in its chronic form, in a habitual way, initially presents with no symptoms or alterations in the electrocardiogram or chest x-ray characterizing the Indeterminate Form, which can generally last from 30 to 40 years.…”

Section: Introductionmentioning

confidence: 99%

Insuficiência cardíaca grave e rapidamente progressiva em paciente adulto jovem com cardiomiopatia chagásica crônica: desafio diagnóstico e terapêutico

Morais

Souza

Tomazini

et al. 2020

Rev. Med. (São Paulo)

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A Doença de Chagas é responsável por 12 mil mortes anualmente nas Américas em decorrência da Cardiomiopatia Chagásica crônica (CCC) que ocorre em 20 a 30% dos infectados, após os 60 anos, 30 a 40 anos após a primo-infecção, levando à Insuficiência Cardíaca (IC) biventricular, arritmias, bloqueios e embolias. O diagnóstico é baseado na epidemiologia, quadro clínico, alterações eletrocardiográficas e de exames de imagem associados à sorologia. O presente estudo relata o caso de paciente com evolução atípica para a idade devido à rápida progressão para IC avançada e refratária, associada à alta morbimortalidade, manifestação tipicamente tardia da CCC. Caso clínico: paciente de 37 anos, sexo feminino, internada na Unidade de Terapia Intensiva de um hospital terciário no interior do Estado de São Paulo por IC congestiva descompensada, associada a derrame pleural. O ecocardiograma e sorologia para Trypanossoma Cruzi confirmaram o diagnóstico de CCC e risco de mortalidade estimado em 84%. Foi iniciado tratamento com betabloqueador, espironolactona, diurético, enalapril e paciente recebeu alta. Após 20 meses, reinternou com choque cardiogênico, síndrome cardiorrenal e fibrilação atrial tratados com diuréticos, inotrópicos e amiodarona, evoluindo para óbito após três dias. Não foi possível encaminhamento para terapia de ressincronização ou transplante cardíaco, devido à comorbidade psiquiátrica, má adesão medicamentosa e indisponibilidade no serviço. A precocidade da apresentação da IC avançada e refratária, neste caso, revela a importância da adesão ao tratamento medicamentoso, redução de reinternações e o rápido referenciamento a centro de transplante e suporte ventricular, como tentativa de diminuir a morbimortalidade desses pacientes.

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Chronic Chagas Cardiomyopathy Patients and Resynchronization Therapy: a Survival Analysis

Cited by 7 publications

References 33 publications

Route of inoculation influences Trypanosoma congolense and Trypanosoma brucei brucei virulence in Swiss white mice

Route of inoculation influences Trypanosoma congolense and Trypanosoma brucei brucei virulence in Swiss white mice

Chagas Disease and Heart Failure: An Expanding Issue Worldwide

Insuficiência cardíaca grave e rapidamente progressiva em paciente adulto jovem com cardiomiopatia chagásica crônica: desafio diagnóstico e terapêutico

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