Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Arrhythmogenic Manifestations of Chagas Disease: Perspectives From the Bench to Bedside

“…Some of the new potential therapies for CCM lack information on its effects on the electrical function of cardiomyocytes, which makes it hard to optimize treatment guidelines, especially because CCM is a primarily arrhythmogenic pathological entity. 2 To accomplish the goal of improving the therapeutic control of such a complex disease, a more comprehensive and integrated understanding of functional remodeling of the cardiovascular system, as proposed in this review, is necessary.…”

“…Apart from the incorporation of ventricular arrhythmia (nonsustained VT) in the RASSI score, other electrical indicators of adverse prognosis have been proposed by other authors, including increased T-wave amplitude variability, abnormal T-wave axis deviation, QT interval dispersion, signal-averaged ECG changes (spectral turbulence and filtered QRS), decreased heart rate variability, and increased QRS complex duration. 2 However, these additional factors still lack external validation by independent cohort studies.…”

“…Chagas disease (CD), a parasitic infection caused by the intracellular protozoan Trypanosoma cruzi ( T. cruzi ), 1 is endemic in regions of Mexico, Central America, and South America, affecting ≈6 to 7 million people. 2 In the United States, it is estimated that 288 000 individuals, predominantly immigrants, are living with CD, which they acquired primarily in Latin American countries. 3 Domestic transmission within the United States through contact with triatomine bugs, the disease’s primary vector, is relatively rare.…”

“…Both the acute and chronic phases of CD are influenced by various factors, including the virulence of the T. cruzi strain, the initial load of the parasite, the route of transmission, the parasite’s ability to evade the immune system, the host’s genetic background, nutritional status, and immune response. 2 The most common and severe manifestation of chronic CD is Chagas cardiomyopathy (CCM), appearing in nearly one-third of individuals with CD. Notably, CCM has a poor prognosis, with an estimated overall annual mortality of 4%.…”

Cardiomiopatia chagásica: alterações anatômicas e eletrocardiográficas

“…O parasita T. cruzi é, principalmente, transmitido através da inoculação cutânea ou ingestão de alimentos com fezes contaminadas dos triatomíneos, ou bicho-barbeiro, que são insetos. É importante destacar que a forma mais comum de transmissão no Brasil atualmente é a via oral, pois em 2006 foi reconhecido que o Brasil erradicou a transmissão da doença pelo mais relevante vetor domiciliado, o Triatoma infestans (MARIN-NETO et al, 2023). Ademais, há casos em que ocorre a transmissão através de transfusão sanguíneo ou transversal -de mãe para feto (RALSTON et al, 2023).…”