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Original Research

Prevalence and Risk Factors of Embolic Cerebrovascular Events Associated With Chagas Heart Disease

Authors:

Maria Carmo P. Nunes ,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Lucas Jordan Kreuser,

University of Minnesota Medical School, Minneapolis, MN, US
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Antonio Luiz Ribeiro,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Giovane Rodrigo Sousa,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Henrique Silveira Costa,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Fernando Antonio Botoni,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Aline Cristina de Souza,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Vitoria Emilia Gomes Marques,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Antonio B. Fernandez,

Division of Cardiology, Hartford Hospital, Hartford, CT, US
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Antonio Lucio Teixeira,

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Manoel Otávio da Costa Rocha

Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, BR
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Abstract

Background: Patients with Chagas disease are at increased risk for stroke that may result in major clinical disability and death. Identification of risk factors involved in the genesis of thromboembolic events related to this disease may lead to improved therapeutic decision making and outcomes.

Objectives: This study sought to assess the prevalence of ischemic cerebrovascular events (ICE) among patients with Chagas heart disease and to identify the risk factors associated with cardioembolism in this population.

Methods: This study involved 330 patients, 193 were men (58%), with a mean age of 49 ± 12 years with Chagas disease classified in the chronic cardiac form of the disease. Comprehensive echocardiography was performed to search a substrate for cardioembolic events, especially apical aneurysm and intracavitary thrombus.

Results: Most of the patients were classified as New York Heart Association classes I or II (75%) with mean left ventricular (LV) ejection fraction of 39 ± 14%. Sixty-seven patients had a previous ICE with the overall prevalence of 20%. Apical aneurysms were detected in 128 patients (39%), whereas LV mural thrombi were found in 48 patients (15%). In multivariate analysis including the potential predictors of ICE, apical aneurysm (adjusted odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.11 to 4.34; p = 0.024) and LV thrombus (adjusted OR: 2.43, 95% CI: 1.09 to 5.42; p = 0.030) emerged as important determinants of ICE, after adjusting for anticoagulation therapy.

Conclusions: In a selected population referred to a tertiary center for Chagas disease that included patients with different severities of cardiac involvement, the prevalence of ICE was 20%. The presence of apical aneurysm and intracavitary thrombus were independently associated with ICE, after adjustment for other risk factors for stroke.

Highlights

  • Chagas disease is a risk factor for stroke.
  • Stroke can be the first clinical manifestation of the Chagas disease.
  • Cardioembolism is the main mechanism of stroke in Chagas disease.
  • Left ventricular apical aneurysm and thrombus are associated with ischemic cerebrovascular events in Chagas heart disease.
  • Transthoracic echocardiography can identify patients at risk of ischemic cerebrovascular events.
How to Cite: Nunes MCP, Kreuser LJ, Ribeiro AL, Sousa GR, Costa HS, Botoni FA, et al.. Prevalence and Risk Factors of Embolic Cerebrovascular Events Associated With Chagas Heart Disease. Global Heart. 2015;10(3):151–7. DOI: http://doi.org/10.1016/j.gheart.2015.07.006
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Published on 01 Sep 2015.
Peer Reviewed

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