Estratégias de prevenção do acidente vascular encefálico cardioembólico na doença de Chagas

Sousa, Andréa Silvestre de; Xavier, Sérgio Salles; Freitas, Gabriel R. de; Hasslocher‐Moreno, Alejandro Marcel

doi:10.1590/s0066-782x2008001700004

Cited by 53 publications

(44 citation statements)

References 11 publications

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“…In general, anticoagulation is recommended for patients with Chagas disease who have permanent/paroxysmal atrial fibrillation, previous thromboembolic events, or the presence of a cardiac thrombus detected by echocardiography. [127] Sousa et al, prospectively studying 1043 patients with chronic Chagas disease,[128] developed a risk score for ischemic attacks. LV dysfunction was given 2 points and apical aneurism, abnormalities of the ST-T segment and age >48 years, 1 point each.…”

Section: Heart Failure: Advances In Pharmacological Treatmentmentioning

confidence: 99%

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: Heart Failure: Advances In Pharmacological Treatmentmentioning

confidence: 99%

Developments in the management of Chagas cardiomyopathy

Tanowitz

Machado

Spray

et al. 2015

Expert Review of Cardiovascular Therapy

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“…Few observational studies have been done on risk correlates for stroke in Chagas cardiomyopathy, most have focused on CD as a risk factor without establishing a differentiation between CD itself and the chagasic cardiomyopathy and present significant heterogeneity in sampling and methods [24]–[29]. Only one study was performed specifically to determine the risk factors for stroke in chagasic patients who already presented with a cardiomyopathy [30].…”

Section: Introductionmentioning

confidence: 99%

Stroke Correlates in Chagasic and Non-Chagasic Cardiomyopathies

et al. 2012

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BackgroundAging and migration have brought changes to the epidemiology and stroke has been shown to be independently associated with Chagas disease. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology.Methodology/Principal FindingsWe performed a cross-sectional review of medical records of 790 patients with a cardiomyopathy. Patients with chagasic (329) and non-chagasic (461) cardiomyopathies were compared. There were 108 stroke cases, significantly more frequent in the Chagas group (17.3% versus 11.1%; p<0.01). Chagasic etiology (odds ratio [OR], 1.79), pacemaker (OR, 2.49), atrial fibrillation (OR, 3.03) and coronary artery disease (OR, 1.92) were stroke predictors in a multivariable analysis of the entire cohort. In a second step, the population was split into those with or without a Chagas-related cardiomyopathy. Univariable post-stratification stroke predictors in the Chagas cohort were pacemaker (OR, 2.73), and coronary artery disease (CAD) (OR, 2.58); while atrial fibrillation (OR, 2.98), age over 55 (OR, 2.92), hypertension (OR, 2.62) and coronary artery disease (OR, 1.94) did so in the non-Chagas cohort. Chagasic stroke patients presented a very high frequency of individuals without any vascular risk factors (40.4%; OR, 4.8). In a post-stratification logistic regression model, stroke remained associated with pacemaker (OR, 2.72) and coronary artery disease (OR, 2.60) in 322 chagasic patients, and with age over 55 (OR, 2.38), atrial fibrillation (OR 3.25) and hypertension (OR 2.12; p = 0.052) in 444 non-chagasic patients.Conclusions/SignificanceChagas cardiomyopathy presented both a higher frequency of stroke and an independent association with it. There was a high frequency of strokes without any vascular risk factors in the Chagas as opposed to the non-Chagas cohort. Pacemaker rhythm and CAD were independently associated with stroke in the Chagas group while age over 55 years, hypertension and atrial fibrillation did so in the non-Chagas cardiomyopathies.

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“…Cardiac disease manifests as cardiomyopathy with congestive heart failure (CHF), arrhythmia, conduction blocks, thromboembolism and sudden death. Few studies have evaluated thromboembolic events in Chagas disease [2,3,4]. Furthermore, Chagas disease is a well-defined risk factor for stroke, independent of cardiac disease severity [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Stroke History and Chagas Disease Are Independent Predictors of Silent Cerebral Microembolism in Patients with Congestive Heart Failure

et al. 2010

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Background: Chagas disease is endemic in South and Central America, where 18 million individuals are infected by Trypanosoma cruzi, causing congestive heart failure (CHF) and cardioembolic stroke. Transcranial Doppler (TCD) is able to detect real-time microembolic signals (MES) to the brain vessels and may represent a surrogate marker of stroke risk. We aimed to determine predictors of MES in a population of patients with CHF. Methods: Consecutive CHF patients from a university-based cardiomyopathy clinic underwent TCD recording of the middle cerebral artery for 60 min by a single investigator who was blinded to all clinical data including cardiomyopathy etiology. Predictors of MES were sought by multivariable logistic regression analysis. Results: From April 2004 to February 2009, 144 patients were studied, including 62 (44.6%) patients with Chagas disease. MES were detected in 9 (6.2%) patients and were more frequent in patients with Chagas disease than in patients with other causes of CHF (12.9 vs. 1.2%, p = 0.005). In multivariate analysis corrected for age and left-ventricular ejection fraction, predictors of MES were Chagas disease (odds ratio = 1.15, 95% confidence interval = 1.05–1.26, p = 0.004) and stroke history (odds ratio = 1.27, 95% confidence interval = 1.08–1.50, p = 0.005). Conclusions: Chagas disease and stroke history are risk factors for MES independent of cardiac disease severity. Other mechanisms besides structural cardiac disease may be operative, increasing embolic risk in Chagas disease.

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Estratégias de prevenção do acidente vascular encefálico cardioembólico na doença de Chagas

Abstract: SummaryBackground: The cardioembolic (CE) ischemic stroke is an important clinical manifestation of chronic chagasic cardiopathy; however, its incidence and the risk factors associated to this event have yet to be defined.

Cited by 53 publications

References 11 publications

Developments in the management of Chagas cardiomyopathy

Developments in the management of Chagas cardiomyopathy

Stroke Correlates in Chagasic and Non-Chagasic Cardiomyopathies

Stroke History and Chagas Disease Are Independent Predictors of Silent Cerebral Microembolism in Patients with Congestive Heart Failure

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