Long-Term Cardiac Outcomes of Treating Chronic Chagas Disease with Benznidazole versus No Treatment

Viotti, Rodolfo; Vigliano, Carlos; Lococo, Bruno; Bertocchi, Graciela; Petti, Marcos; Alvarez, M; Postan, Miriam; Armenti, Alejandro

doi:10.7326/0003-4819-144-10-200605160-00006

Cited by 533 publications

(478 citation statements)

References 33 publications

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“…These results coincide with those of other researchers who have used the same doses and period for benznidazole administration (5mg/ kg/day over 30 days) 24,25 .…”

Section: Discussionsupporting

confidence: 82%

Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease

Fabbro

Velázquez

Bizai

et al. 2013

Rev. Inst. Med. trop. S. Paulo

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SUMMARYThis work compared the time at which negative seroconversion was detected by conventional serology (CS) and by the ELISA-F29 test on a cohort of chronic chagasic patients treated with nifurtimox or benznidazole. A retrospective study was performed using preserved serum from 66 asymptomatic chagasic adults under clinical supervision, and bi-annual serological examinations over a mean follow-up of 23 years. Twenty nine patients received trypanocide treatment and 37 remained untreated. The ELISA-F29 test used a recombinant antigen which was obtained by expressing the Trypanosoma cruzi flagellar calcium-binding protein gene in Escherichia coli. Among the untreated patients, 36 maintained CS titers. One patient showed a doubtful serology in some check-ups. ELISA-F29 showed constant reactivity in 35 out of 37 patients and was negative for the patient with fluctuating CS. The treated patients were divided into three groups according to the CS titers: in 13 they became negative; in 12 they decreased and in four they remained unchanged. ELISA-F29 was negative for the first two groups. The time at which negativization was detected was significantly lower for the ELISA-F29 test than for CS, 14.5 ± 5.7 and 22 ± 4.9 years respectively. Negative seroconversion was observed in treated patients only. The results obtained confirm that the ELISA-F29 test is useful as an early indicator of negative seroconversion in treated chronic patients.

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“…These results coincide with those of other researchers who have used the same doses and period for benznidazole administration (5mg/ kg/day over 30 days) 24,25 .…”

Section: Discussionsupporting

confidence: 82%

Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease

Fabbro

Velázquez

Bizai

et al. 2013

Rev. Inst. Med. trop. S. Paulo

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“…The identification of predictive factors associated with the risk for AF has been a general concern since the Framingham study, and several factors have been associated with a higher incidence of AF in the general population (18,(25)(26)(27)(28)(29)(30). In the present study, the prevalence of systemic arterial hypertension did not differ across Los Andes groups on admission (Table 1) and neither the distribution of systemic hypertension nor drug therapy to control blood pressure among subjects who experienced and did not experience AF was statistically different at the end of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

Benchimol-Barbosa

Barbosa-Filho

2009

Braz J Med Biol Res

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Atrial fibrillation (AF) affects subjects with Chagas' disease and is an indicator of poor prognosis. We investigated clinical, echocardiographic and electrocardiographic variables of Chagas' disease in a long-term longitudinal study as predictors of a new-onset AF episode lasting >24 h, nonfatal embolic stroke and cardiac death. Fifty adult outpatients (34 to 74 years old, 62% females) staged according to the Los Andes classification were enrolled. During a follow-up of (mean ± SD) 84.2 ± 39.0 months, 9 subjects developed AF (incidence: 3.3 ± 1.0%/year), 5 had nonfatal stroke (incidence: 1.3 ± 1.0%/year), and nine died (mortality rate: 2.3 ± 0.8%/year). The progression rate of left ventricular mass and left ventricular ejection fraction was significantly greater in subjects who experienced AF (16.4 ± 20.0 g/year and -8.6 ± 7.6%/year, respectively) than in those who did not (8.2 ± 8.4 g/year; P = 0.03, and -3.0 ± 2.5%/year; P = 0.04, respectively). In univariate analysis, left atrial diameter ≥3.2 cm (P = 0.002), pulmonary arterial hypertension (P = 0.035), frequent premature supraventricular and ventricular contraction counts/ 24 h (P = 0.005 and P = 0.007, respectively), ventricular couplets/24 h (P = 0.002), and ventricular tachycardia (P = 0.004) were long-term predictors of AF. P-wave signal-averaged ECG revealed a limited long-term predictive value for AF. In chronic Chagas' disease, large left atrial diameter, pulmonary arterial hypertension, frequent supraventricular and ventricular premature beats, and ventricular tachycardia are long-term predictors of AF. The rate of left ventricular mass enlargement and systolic function deterioration impact AF incidence in this population.

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“…Based on the literature, the probability of moving from the indeterminate form to the cardiac form was set at 2% a year for the no-test option (progression to cardiomyopathy in untreated patients 22 ) and at 0·5% for the test option. 7 The probability of moving to the gastrointestinal form was conservatively considered at 0·3% a year for both options based on little evidence that antitrypanosomal therapy mitigates the risk of progression to intestinal disease. 22 The probability of death attributable to Chagas disease was 3·9% in patients with cardiomyopathy and was set at zero in both indeterminate and gastrointestinal forms 23 (appendix p 2).…”

Section: Disease States and Transition Probabilitiesmentioning

confidence: 99%

“…6 However, this practice is based on evidence from only one open-label, non-randomised, non-blinded trial and from other longitudinal studies that have shown decreased progression of cardiomyopathy and mortality. 7,8 In Europe, transmission from individuals infected with Tripanosoma cruzi (T cruzi), including from those who are asymptomatic, occurs either vertically or through transfusion of infected blood products or transplantation of infected organs. 9 Screening programmes are currently recommended in blood-banks and transplant settings and have already been implemented in some European countries, such as Spain, the UK, and Switzerland.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis

Requena‐Méndez

Bussion

Aldasoro

et al. 2017

The Lancet Global Health

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SummaryBackground Chagas disease is currently prevalent in European countries hosting large communities from Latin America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screening of the Latin American population attending primary care centres in Europe.

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Long-Term Cardiac Outcomes of Treating Chronic Chagas Disease with Benznidazole versus No Treatment

Cited by 533 publications

References 33 publications

Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease

Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis

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