Clinical predictors of chronic chagasic myocarditis progression. Rev Esp Cardiol

Servicio de Cardiología, Hospital Eva Perón, San Martín, Buenos Aires, Argentina.
Revista Espa de Cardiologia (Impact Factor: 3.79). 09/2005; 58(9):1037-44. DOI: 10.1016/S1885-5857(06)60436-2
Source: PubMed


Previous prognostic studies of Chagas' disease have focused on mortality associated with end-stage cardiopathy (i.e., heart failure). Our aim was to identify indicators of progression in early-stage Chagas' heart disease.
The study included 856 patients with 3 positive anti-Trypanosoma cruzi test results. Those with heart failure were excluded. Patients were divided into 3 clinical groups: those without heart disease (Group I); those with heart disease but without left ventricular enlargement (Group II); and those with left ventricular enlargement but without heart failure (Group III). The endpoint was progression to a more severe clinical stage or death due to cardiovascular disease. A Cox regression model was used to derive a clinical risk score from clinical, electrocardiographic and echocardiographic variables.
At study entry, the patients' mean age was 43.7 years. They were followed up for a mean of 8 years. The following were predictors of heart disease progression: age at entry (HR=1.05; 95% CI, 1.02-1.07; P<.001), left ventricular systolic diameter (HR=1.06; 95% CI, 1.04-1.09; P<.001), intraventricular conduction abnormalities (HR=1.85; 95% CI, 1.02-3.36; P=.04), and sustained ventricular tachycardia (HR=3.97; 95% CI, 1.65-9.58; P=.002). Treatment with benznidazole reduced the risk of progression (HR=0.40; 95% CI, 0.23-0.72; P=.002). The devised clinical risk score was effective in stratifying the likelihood of cardiopathy progression.
Specific clinical indicators and a derived clinical risk score can be used to predict the progression of chronic chagasic myocarditis in patients without heart failure.

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    • "The prognosis of patients with heart failure or advanced stages of Chagas' cardiomyopathy is poor [72], but similar to others that develop heart failure for other reasons. Since the disease is chronic and heart damage develops over decades, it is very important to recognize factors that are determinant of disease progression in the early stages [73]. Etiological treatment should be considered as a protective factor in the model of physiopathology of Chagas' cardiomyopathy. "
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    ABSTRACT: This paper reviews the evidence supporting the use of etiological treatment for Chagas disease that has changed the standard of care for patients with Trypanosoma cruzi infection in the last decades. Implications of this evidence on different levels of prevention as well as gaps in current knowledge are also discussed. In this regard, etiological treatment has shown to be beneficial as an intervention for secondary prevention to successfully cure the infection or to delay, reduce, or prevent the progression to disease, and as primary disease prevention by breaking the chain of transmission. Timely diagnosis during initial stages would allow for the prescription of appropriate therapies mainly in the primary health care system thus improving chances for a better quality of life. Based on current evidence, etiological treatment has to be considered as an essential public health strategy useful to reduce disease burden and to eliminate Chagas disease altogether.
    Journal of Tropical Medicine 03/2012; 2012:292138. DOI:10.1155/2012/292138
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    • "Ventricular arrhythmias during stress testing were also predictors of worsening disease from a clinical point of view (Viotti et al. 2006b). A clinical score based on the risk of progression of heart disease has shown an adequate capacity to differentiate varying prognoses of patients with chronic CD (Viotti et al. 2005). "
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    ABSTRACT: The purpose of this review is to describe research findings regarding chronic Chagas disease in Argentina that have changed the standards of care for patients with Trypanosoma cruzi infection. Indirect techniques (serological tests) are still the main tools for the primary diagnosis of infection in the chronic phase, but polymerase chain reaction has been shown to be promising. The prognosis of patients with heart failure or advanced stages of chagasic cardiomyopathy is poor, but a timely diagnosis during the initial stages of the disease would allow for prescription of appropriate therapies to offer a better quality of life. Treatment of T. cruzi infection is beneficial as secondary prevention to successfully cure the infection or to delay, reduce or prevent the progression to disease and as primary disease prevention by breaking the chain of transmission. Current recommendations have placed the bulk of the diagnostic and treatment responsibility on the Primary Health Care System. Overall, the current research priorities with respect to Chagas disease should be targeted towards (i) the production of new drugs that would provide a shorter treatment course with fewer side effects; (ii) the development of new tools to confirm cure after a full course of treatment during the chronic phase and (iii) biomarkers to identify patients with a high risk of developing diseases.
    Memórias do Instituto Oswaldo Cruz 07/2009; 104 Suppl 1(Suppl 1):167-80. DOI:10.1590/S0074-02762009000900023 · 1.59 Impact Factor
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