Progression Rate from the Indeterminate Form to the Cardiac Form in Patients with Chronic Chagas Disease: Twenty-Two-Year Follow-Up in a Brazilian Urban Cohort

Abstract

Most patients with chronic Chagas disease (CD) present the indeterminate form and are at risk to develop the cardiac form. However, the actual rate of progression to the cardiac form is still unknown. Methods: In total, 550 patients with the indeterminate CD form were followed by means of annual electrocardiogram at our outpatient clinic. The studied endpoint was progression to cardiac form defined by the appearance of electrocardiographic changes typical of CD. The progression rate was calculated as the cumulative progression rate and the incidence progression rate per 100 patient years. Results: Thirty-seven patients progressed to the CD cardiac form within a mean of 73 ± 48 months of follow-up, which resulted in a 6.9% cumulative progression rate and incidence rate of 1.48 cases/100 patient years. Patients who progressed were older (mean age 47.8 ± 12.2 years), had a higher prevalence of associated heart diseases (p < 0.0001), positive xenodiagnosis (p = 0.007), and were born in the most endemic Brazilian states (p = 0.018). Previous co-morbidities remained the only variable associated with CD progression after multivariate Cox proportional hazards regression analysis (p = 0.002). Conclusion: The progression rate to chronic CD cardiac form is low and inferior to rates previously reported in other studies.

Association between Trypanosoma cruzi DTU TcII and chronic Chagas disease clinical presentation and outcome in an urban cohort in Brazil

“…No patient with the indeterminate form progressed to the cardiac form during the study period. However, Chagas disease progression rate from indeterminate to the cardiac form of our cohort is low, 1.48 cases/100 patient years [ 35 ], and probably the low number of patients with the indeterminate form and their relatively short period of follow-up in the present study is not appropriated to address Chagas disease progression.…”

“…The epidemiological characteristics of the studied sample of the present article were representative of the group of patients followed at the outpatient clinic of our institution, as a recent paper of our group that included 619 Chagas disease patients found similar clinical and epidemiological characteristics, including an elevated mean age and women predominance [ 34 ]. The urban cohorts are usually composed by patients that migrated from rural areas of the states of Bahia, Pernambuco, Paraíba, and Minas Gerais [ 34 , 35 ]. Regarding to clinical forms, there was a predominance of the cardiac form, associated or not to digestive complications (cardiodigestive form), similar to the findings of other studies [ 34 , 36 ].…”

Risk of Chronic Cardiomyopathy Among Patients With the Acute Phase or Indeterminate Form of Chagas Disease

“…Our pooled estimates were consistent with those of previously published studies. 46 , 48 One cohort study sponsored by the National Institutes of Health found an annual cardiomyopathy progression rate of 1.85% at 10 years of follow-up among patients with asymptomatic Chagas disease, which had been detected because the individuals had donated blood. 46 A more recently published Brazilian cohort study also found a similar annual progression rate of 1.48% at 22 years of follow-up.…”

“… 46 A more recently published Brazilian cohort study also found a similar annual progression rate of 1.48% at 22 years of follow-up. 48 Guidelines from the American Heart Association cite an annual rate of progression from the indeterminate chronic form of Chagas disease to cardiomyopathy of 1.85% to 7.0%. 49 …”

New Contributions to the Elimination of Chagas Disease as a Public Health Problem: Towards the Sustainable Development Goals by 2030

“…Their data indicate the effectiveness of treatment for people living in outreach areas. In another paper, Hasslocher-Moreno et al [ 8 ] describe a progression rate of about 7% from the indeterminate to the chronic form of the disease, in a 22-year cohort study, which is lower than usually expected. In an opinion paper, Mendes et al [ 9 ] discuss the importance of the IPEC-FIOCRUZ score—a tool for identifying patients at higher risk—for the prophylaxis against cardioembolic stroke, in patients with Chagas disease.…”