Cardiac Evaluation in the Acute Phase of Chagas' Disease with Post-Treatment Evolution in Patients Attended in the State of Amazonas, Brazil

Abstract

BackgroundIn the past two decades, a new epidemiological profile of Chagas' disease (CD) has been registered in the Brazilian Amazon where oral transmission has been indicated as responsible for the increase of acute cases. In the Amazonas state, five outbreaks of acute CD have been registered since 2004. The cardiac manifestations in these cases may be characterized by diffuse myocarditis, with alteration in the electrocardiogram (ECG) and transthoracic echocardiogram (TTE).ObjectiveTo perform a cardiac evaluation in autochthonous patients in the acute phase and at least one year after submitted to treatment for acute CD and evaluate the demographic variables associated with the presence of cardiac alterations.MethodsWe evaluated patients diagnosed with acute CD through direct parasitological or serological (IgM) methods from 2007 to 2015. These patients were treated with benznidazole and underwent ECG and TTE before and after treatment. We assumed a confidence interval of 95% (CI 95%, p < 0.05) for all variables analyzed.ResultsWe observed 63 cases of an acute CD in which oral transmission corresponded to 75%. Cardiac alterations were found in 33% of the cases, with a greater frequency of ventricular repolarization alteration (13%), followed by pericardial effusion (10%) and right bundle branch block and left anterior fascicular block (2%). The follow-up occurred in 48 patients with ECG and 25 with TTE for a mean period of 15.5 ± 4.1 months after treatment. Of these, 8% presented normalization of the cardiac alterations in ECG, 62.5% remained with the normal exams. All of the patients presented normal results in TTE in the post-treatment period. As for the demographic variables, isolated cases presented more cardiac alterations than outbreaks (p = 0.044) as well as cases from Central Amazonas mesoregion (p = 0.020).ConclusionsAlthough cardiac alterations have not been frequent in most of the studied population, a continuous evaluation of the clinical-epidemiological dynamics of the disease in the region is necessary in order to establish preventive measures.

Risk of Chronic Cardiomyopathy Among Patients With the Acute Phase or Indeterminate Form of Chagas Disease

“…Nine studies 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 included longitudinal observational outcomes for patients with acute Chagas infection ( Table 2 ). These studies were primarily case series or prospective cohorts performed between 1940 and 2006 in Brazil, Venezuela, and El Salvador.…”

The Selvester QRS score as an estimative of myocardial injury in acute chagasic patients from the Brazilian Amazon

“…In Brazil, more precisely in the Amazon region of Brazil, in recent decades, there has been an important increase in the number of cases, especially in acute forms, including cases with cardiac impairment, and electrocardiographic and echocardiographic alterations [ 6 ].…”

Heart Failure Awareness Day: A Tribute to the Genius Carlos Chagas

“…A unique fact in the history of Medicine, in which a single researcher describes the vector, the etiological agent, identifies the hosts and attempts to identify the clinical forms of the disease. 4 The theme of Chagas’ disease, in our country, remains contemporary, not only in the search for new treatments, 5 vaccines and new forms of contamination, such as the oral route described in the north, northeast and south regions, involving sugarcane and açaí, reported this year in the Brazilian Archives of Cardiology, 6 but also in the current outbreak of acute Chagas’ disease in Pernambuco, still in the process of clarification. Tribute has been paid to scientist Carlos Chagas in Brazil in several ways (Figure 1), but we have identified that his contribution to cardiology and HF was definitive and important, representing his remarkable name for this noble cause in our country.…”