Chagas Cardiomyopathy in the Context of the Chronic Disease Transition

Abstract

BackgroundPatients with Chagas disease have migrated to cities, where obesity, hypertension and other cardiac risk factors are common.Methodology/Principal FindingsThe study included adult patients evaluated by the cardiology service in a public hospital in Santa Cruz, Bolivia. Data included risk factors for T. cruzi infection, medical history, physical examination, electrocardiogram, echocardiogram, and contact 9 months after initial data collection to ascertain mortality. Serology and PCR for Trypanosoma cruzi were performed. Of 394 participants, 251 (64%) had confirmed T. cruzi infection by serology. Among seropositive participants, 109 (43%) had positive results by conventional PCR; of these, 89 (82%) also had positive results by real time PCR. There was a high prevalence of hypertension (64%) and overweight (body mass index [BMI] >25; 67%), with no difference by T. cruzi infection status. Nearly 60% of symptomatic congestive heart failure was attributed to Chagas cardiomyopathy; mortality was also higher for seropositive than seronegative patients (p = 0.05). In multivariable models, longer residence in an endemic province, residence in a rural area and poor housing conditions were associated with T. cruzi infection. Male sex, increasing age and poor housing were independent predictors of Chagas cardiomyopathy severity. Males and participants with BMI ≤25 had significantly higher likelihood of positive PCR results compared to females or overweight participants.ConclusionsChagas cardiomyopathy remains an important cause of congestive heart failure in this hospital population, and should be evaluated in the context of the epidemiological transition that has increased risk of obesity, hypertension and chronic cardiovascular disease.

Prevalence and Risk Factors for Chagas Disease in Pregnant Women in Casanare, Colombia

“…Similarly, Hidron and others using a multivariate model reported that longer residence in a disease-endemic province, residence in a rural area, and poor housing conditions were associated with T. cruzi infection. 23 In this respect, it is important to highlight that housing characteristics of the pregnant women included in our study were better in 2010, when the study was conducted, than during their childhood. A lower frequency of this risk factor was observed in 2010.…”

Cavia porcellus as a Model for Experimental Infection by Trypanosoma cruzi

“…49 T. cruzi has been shown to infect adipose tissue, 8 and rapid increases in the prevalence of obesity and metabolic syndrome in Latin America raise the question of how these factors may interact with Chagas cardiomyopathy. 50 Guinea pigs show a distribution of visceral adipose tissue (eg, epicardial and perirenal fat) similar to that of humans, which may facilitate their use as a model for this interaction. 51 Finally, we observed congenital T. cruzi transmission in a few experimentally infected guinea pigs (R.H. Gilman, unpublished data).…”

Circulating Serum Markers and QRS Scar Score in Chagas Cardiomyopathy

“…Blood specimens for this analysis came from two studies: a community-based survey in the Bolivian Chaco and a hospital-based study of heart disease in Santa Cruz, the closest large city to the Chaco. 27,28 The Chaco is a sparsely populated, hot, and semiarid lowland region that encompasses parts of Bolivia, Argentina, Paraguay, and Brazil that has the highest prevalence of T. cruzi infection in the world. 28,29 Serum samples from adults in the community study were eligible for inclusion if confirmed T. cruzi infection status and complete EKG and chest x-ray (CXR) data were available.…”

“…Individuals from the hospital-based study in Santa Cruz were positive for T. cruzi by serology, had complete EKG and CXR data, and were diagnosed with New York Heart Association (NYHA) class III or IV heart disease. 27 In total, 85 individuals (64 individuals from the community study and 21 individuals from the hospital study) were included in this study.…”