Discussing the Score of Cardioembolic Ischemic Stroke in Chagas Disease

Abstract

Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic events. Of all thromboembolic events, stroke is the most feared, due to the high probability of evolution to death or disability. Despite its importance, the actual incidence of cardioembolic ischemic stroke in Chagas disease is not completely known. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC-FIOCRUZ) score aims to propose prophylaxis strategies against cardioembolic ischemic stroke in Chagas disease based on clinical risk–benefit. To date, the IPEC-FIOCRUZ score is considered the best tool to identify patients for stroke prophylaxis in Chagas disease according the Latin American guideline and Brazilian consensus. It can prevent many cardioembolic strokes that would not be predicted, by applying the current recommendations to other cardiopathies. However, the IPEC-FIOCRUZ score still requires external validation to be used in different Chagas disease populations with an appropriate study design.

Association of left ventricular abnormalities with incident cerebrovascular events and sources of thromboembolism in patients with chronic Chagas cardiomyopathy

“…Finally, our study has described the incidence rate of cerebrovascular events and potential sources of thromboembolism in patients with Chagas disease and provided these data stratified by LV systolic dysfunction. The incidence of cardioembolic ischemic stroke in Chagas disease has been poorly described [28]. In another cross-sectional retrospective study of patients with cardiomyopathies, stroke cases were significantly more frequent in the Chagas group than in those with non-Chagas cardiomyopathies [29].…”

Prognosis of chronic Chagas heart disease and other pending clinical challenges

“…Patients with an incidence of zero-one points have an incidence close to zero and do not require prophylaxis. (106) To prevent cardioembolic events in CCC patients, a risk benefit should always be evaluated. (107,108)…”

Vector-borne protozoal infections of the CNS: cerebral malaria, sleeping sickness and Chagas disease

“…The recent emergence of artemisinin-resistance, particularly in Southeast Asia, is a challenge, and newer agents are desirable 18,19 . A spiroindolone, KAE609, which inhibits Plasmodium plasma membrane protein, PfATP4 was effective and safe in a Phase 2 trial in Thailand 20 . It is now being trialled in a multi-country initiative.…”