Clinical and Echocardiographic Predictors of Mortality in Chagasic Cardiomyopathy - Systematic Review

Abstract

Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed), LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease.

Mortality among blood donors seropositive and seronegative for Chagas disease (1996–2000) in São Paulo, Brazil: A death certificate linkage study

“…The most important health consequence of Chagas disease is cardiomyopathy, which over a lifetime occurs in 20–40% of infected persons with an incidence rate of 1.85% per person-year [ 9 ]. In Brazil, it is estimated that in 2013 there were 2 to 3 million infected individuals [ 10 ], of which 600,000 had cardiac and/or gastrointestinal complications. The disease is also responsible for approximately 6,000 deaths per year in Brazil, i.e.…”

Autoantibodies against the immunodominant sCha epitope discriminate the risk of sudden death in chronic Chagas cardiomyopathy

“…Nonprevious symptomatic SD is the principal cause of death in ChP. Electrocardiographic rhythm changes are predictors of both disease severity and outcome, 24 but suppose clinical suspicion or previous diagnosis of abnormalities and implies specialized cardiology units that are largely not available in the poorest endemic areas. Additionally, in nonendemic countries, blinded diagnostic surveys for arrhythmias are required to avoid additional expenses.…”

Echocardiographic Findings in Canine Model of Chagas Disease Immunized with DNA Trypanosoma cruzi Genes

“…In the acute phase, cardiac involvement may occur in up to 90% of cases. After six to eight weeks, most patients show recovery of the clinical manifestations [9]. In the chronic phase of ChD, during which parasites are hidden in target tissues, especially the cardiac and digestive system muscles, different clinical forms may be observed: (i) the asymptomatic form; (ii) the cardiac form, which occurs in around 30% of the patients with disorders of the heart's electrical conduction system, arrhythmia, heart-muscle disorder, heart failure (HF), or secondary embolisms; (iii) the digestive form, with localized lesions and enlargement of the oesophagus and the colon; and (iv) a mixed form (cardiac plus digestive) that affects around 10% of patients.…”

“…Estimated numbers of chagasic cardiopathy cases are highest in Argentina, Brazil, Colombia, Bolivia, and Mexico [1]. Nevertheless, patterns of emigration from Chagas-endemic areas have drastically altered the epidemiology of this disease in the United States, Europe, and other non-endemic regions in recent decades, making it one of the neglected tropical diseases now found in non-endemic areas of the world [8,9].…”