Assessment of the source of ischemic cerebrovascular events in patients with Chagas disease

Junior, José Olímpio Dias; Rocha, Manoel Otávio da Costa; Souza, Aline Cristina de; Kreuser, Lucas Jordan; Dias, Laura Alves de Souza; Tan, Timothy C.; Teixeira, Antônio Lúcio; Nunes, Maria Carmo Pereira

doi:10.1016/j.ijcard.2014.07.266

Cited by 14 publications

(27 citation statements)

References 13 publications

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Section: Stroke and Atrial Fibrillationmentioning

confidence: 99%

“…[89] Several risk factors for stroke have been reported including heart failure, LV systolic dysfunction, left atrial enlargement, apical aneurysm, mural thrombus and arrhythmias. [82,84,85,89] However, stroke may occur in patients without clinical evidence of heart disease; a careful echocardiographic study may reveal mural thrombus and apical aneurysms (Figure 4A & B). [83,90] A cross-sectional study found that the classic vascular risk factors, including hypertension, diabetes mellitus and smoking, are less common in stroke patients with Chagas disease compared with those without.…”

Section: Stroke and Atrial Fibrillationmentioning

confidence: 99%

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Developments in the management of Chagas cardiomyopathy

Tanowitz

Machado

Spray

et al. 2015

Expert Review of Cardiovascular Therapy

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Over 100 years have elapsed since the discovery of Chagas disease and there is still much to learn regarding pathogenesis and treatment. Although there are antiparasitic drugs available, such as benznidazole and nifurtimox, they are not totally reliable and often toxic. A recently released negative clinical trial with benznidazole in patients with chronic Chagas cardiomyopathy further reinforces the concerns regarding its effectiveness. New drugs and new delivery systems, including those based on nanotechnology, are being sought. Although vaccine development is still in its infancy, the reality of a therapeutic vaccine remains a challenge. New ECG methods may help to recognize patients prone to developing malignant ventricular arrhythmias. The management of heart failure, stroke and arrhythmias also remains a challenge. Although animal experiments have suggested that stem cell based therapy may be therapeutic in the management of heart failure in Chagas cardiomyopathy, clinical trials have not been promising.

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Section: Stroke and Atrial Fibrillationmentioning

confidence: 99%

Section: Stroke and Atrial Fibrillationmentioning

confidence: 99%

Developments in the management of Chagas cardiomyopathy

Tanowitz

Machado

Spray

et al. 2015

Expert Review of Cardiovascular Therapy

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“…Apical aneurysms and intracavitary thrombi are the main factors associated with cerebrovascular ischemic events in patients with CD. Subclinical atherosclerosis assessed by carotid IMT does not appear to play a major role in the genesis of ischemic events in CD 39,40 . Therefore, these patients need rigorous follow-up using methods that can detect early changes, considering that the clinical behavior of indeterminate CD is heterogeneous, and factors associated with progression to more severe forms remain unknown.…”

Section: Discussionmentioning

confidence: 85%

Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

Arruda

Ribeiro

Silva

et al. 2019

Rev. Soc. Bras. Med. Trop.

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Introduction: Chagas disease is a major public health problem that is endemic in Brazil and Latin America. This study aimed to determine the socioeconomic, demographic, and clinical characteristics of 171 patients (mean age, 45 years; female, 65%) with Chagas disease at Hospital Universitário de Brasília, Federal District, Brazil. Methods: We implemented this cross-sectional study using a clinical epidemiological questionnaire, electrocardiography, echocardiography, and quantitative detection of Trypanosoma cruzi DNA in blood using qRT-PCR. Results: Among the patients, 26.3% had a full elementary education, and 13.2% were illiterate. Most (63.6%) were economically classified as class C, and 51.5% were born in Bahia state. A total of 62.0% participants reported previous contact with the triatomine bug. The clinical forms of the disease were indeterminate (69.51%), cardiac (15.24%), digestive (10.37%), and mixed (4.88%). The most common electrocardiographic abnormality was complete right bundle branch block in association with a divisional anterosuperior block. Only 14.6% of the patients complied with benznidazole medication for at least 60 days, and 164 of them were assessed by echocardiography. The parasite load was positive in 56% of the patients. Conclusions: Chagas disease affected mostly women, with the indeterminate chronic form of the disease.

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“…Chagas disease is described as an important cause of cardioembolic stroke in some regions of Brazil. However, in Porto Alegre this disorder is not as common as in the central regions of Brazil and South America [ 15 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

Cardioembolic Sources in Stroke Patients in South of Brazil

et al. 2014

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Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.

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Assessment of the source of ischemic cerebrovascular events in patients with Chagas disease

Cited by 14 publications

References 13 publications

Developments in the management of Chagas cardiomyopathy

Developments in the management of Chagas cardiomyopathy

Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

Cardioembolic Sources in Stroke Patients in South of Brazil

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