Mem Inst Oswaldo Cruz, Rio de Janeiro, VOLUME 115 | MAY 2020
Original Article

Chagas disease in Virgem da Lapa, Minas Gerais, Brazil: left ventricle aneurysm and the risk of death in the 24-year interval

José Borges-Pereira1,+, José Rodrigues Coura1, Patrícia Lago Zauza1, Claude Pirmez2, Sérgio Salles Xavier3

1Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil
2Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
3Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Doença de Chagas, Rio de Janeiro, RJ, Brasil

DOI: 10.1590/0074-02760200056
74 views 8 downloads
ABSTRACT

BACKGROUND Left ventricular aneurysm (LVA) is indicator of high morbidity in Chagas’ disease. A cross-sectional study performed identified LVA in 18.8% of the chronic chagasic patients (CCP).
OBJECTIVE Determine the risk of death of patients with chronic chagasic cardiopathy (CCC) and LVA in 24-year interval.
MATERIAL AND METHODS In 1995 a cohort of 298 CCP was evaluated by anamnesis, physical examination, EKG and ECHO and classified in groups: G0 = 86 without cardiopathy; G1 = 156 with cardiopathy without LVA and G2 = 56 with cardiopathy and LVA. 38 patients of G0 and G1 used benznidazole. Information about the deaths was obtained in the notary, death certificates, hospital records and family members.
FINDINGS Were registered 113 deaths (37.9%): 107 (35.9%) attributed to cardiopathy and 6 (2.0%) to other causes (p < 0.05). Amongst these 107 deaths, 10 (11.6%) occurred in G0; 49 (31.4%) occurred in G1 and 48 (85.7%) occurred in G2 (p < 0.05). The risk of death was 2.7 and 7.4 times significantly higher in G2, than in G1 and G0, respectively.
CONCLUSION Chronic chagasic patients with LVA and ejection fraction < 45% have a higher risk of death than those without.

REFERENCES
01. Dias JCP, Ramos Jr NA, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Xavier SS, et al. II Brazilian Consensus on Chagas Disease, 2015. Epidemiol Serv Saude. 2016; 25(Esp): 7-86.
02. Chagas C, Villela E. Cardiac form of American Trypanosomiasis. Mem Inst Oswaldo Cruz. 1922; 14(1): 5-61.
03. Coura JR, Abreu LL, Dubois LEG, Correia-Lima F, Arruda Jr E, Willcox HPF, et al. Morbidade da doença de Chagas. II – Estudos seccionais em quatro áreas de campo no Brasil. Mem Inst Oswaldo Cruz. 1984; 79(1): 101-24.
04. Borges-Pereira J, Willcox HP, Coura JR. Morbidade da doença de Chagas. III - Estudo longitudinal de seis anos, em Virgem da Lapa, MG, Brasil. Mem Inst Oswaldo Cruz. 1985; 80(1): 63-71.
05. Borges-Pereira J, Zauza PL, Galhardo MC, Nogueira JS, Pereira GROL, Cunha RV. Chagas disease in the urban population of the sanitary district of Rio Verde, Mato Grosso do Sul, Brazil. Rev Soc Bras Med Trop. 2001; 34: 459-66.
06. Borges-Pereira J, Castro JAF, Campo JHF, Nogueira JS, Zauza PL, Marques P, et al. Study of the infection and morbidity of Chagas’ disease in municipality of João Costa - National Park Serra da Capivara, Piauí, Brazil. Rev Soc Bras Med Trop. 2002; 35(4): 315-22.
07. Mott E, Lehman JS, Hoff R, Morrow RH, Muniz TM, Sherlock I, et al. The epidemiology and household distribution of seroreactivity to Trypanosoma cruzi in a rural community in Northeast Brazil. Am J Trop Med Hyg. 1976; 25: 552-62.
08. Laranja FS, Dias E, Nobrega GC, Miranda A. Chagas disease: a clinical epidemiological and pathologic study. Circulation. 1956; 14: 1035-60.
09. Kloetzel K, Dias JCP. Mortality in Chagas disease: life table for the period 1949-1967 in an unselected population. Rev Inst Med Trop São Paulo. 1968; 10: 5-8.
10. Dias JCP, Kloetzel K. The prognostic value of the electrocardiographic features of chronic Chagas disease. Rev Inst Med Trop São Paulo. 1968; 10: 158-62.
11. Andrade ZA. Apical lesion of the heart in chagasic chronic myocarditis. Hospital. 1956; 50: 803-12.
12. Acquatella H, Schiller NB, Puigbó JJ, Giordano H, Suarez JA, Casal H, et al. M-mode and two-dimensional echocardiography in chronic Chagas’ heart disease. Circulation. 1980; 62: 787-95.
13. Borges-Pereira J, Xavier SS, Pirmez C, Coura JR. Chagas’ disease in Virgem da Lapa County, Minas Gerais State, Brazil. IV. Clinical and epidemiological aspects of the left ventricle aneurysm. Rev Soc Bras Med Trop. 1998; 31(5): 457-63.
14. Viotti RJ, Vigliano C, Loucella S, Lococo B, Petti M, Bertocchi G, et al. Value of echocardiography for diagnosis and prognosis of chronic Chagas disease cardiomyopathy without heart failure. Heart. 2003; 90: 655-60.
15. Borges-Pereira J, Xavier SS, Sousa AS, Castro JAF, Zauza PL, Coura JR. Prevalence of left ventricular aneurysms among chronic Chagas disease patients from two areas in the State of Piauí, Brazil. Rev Soc Bras Med Trop. 2007; 40(5): 521-6.
16. Xavier SS, de Sousa AS, do Brasil PEAA, Gabriel FG, de Holanda MT, Hasslocher-Moreno A, et al. Apical aneurysm in the chronic phase of Chagas disease: prevalence and prognostic value in an urban cohort of 1053 patients. Rev SOCERJ. 2005; 18(4): 351-6.
17. Albanesi-Filho FM, Gomes Filho JB. Thromboembolism in patients with apical injury caused by chronic Chagas heart disease. Rev Port Cardiol. 1991; 10: 35-42.
18. Sousa AS, Xavier SS, Freitas GR, Moreno AH. Strategies for preventing cardioembolic stroke in Chagas disease. Arq Bras Cardiol. 2008; 91: 280-4.
19. Barbosa-Ferreira JM, Nobre AF, Maldonado JGA, Borges-Pereira J, Zauza PL, Coura JR. Ischemic stroke in a chronic chagasic patient autochthonous from the Brazilian Amazon. Rev Soc Bras Med Trop. 2010; 43(6): 751-3.
20. Carvalhal S, Bittencourt LAK, Nogueira EA. Apical lesion in Chagas heart disease. Arq Bras Cardiol. 1980; 35: 171-7.
21. Camargo ME, Silva JR, Castilho EA, Silveira AC. Serological survey of the prevalence of chagasic infection in Brazil, 1975- 1980. Rev Inst Med Trop São Paulo. 1984; 26: 192-204.
22. Borges-Pereira J. Human Chagas disease: study of chronic infection, morbidity and mortality in Virgem da Lapa, Minas Gerais (1976-1996). [PhD Thesis in Tropical Medicine]. Rio de Janeiro: Fundação Oswaldo Cruz; 1997. 197 pp.
23. OMS/OPAS - Organización Mundial de la Salud/Organización Panamericana de la Salud. Aspectos clínicos de la enfermedad de Chagas. Informe de una reunión conjunta OMS/OPAS de investigadores. Bol Ofic Santaria Panamericana. 1974; 76: 141-58.
24. SBC - Sociedade Brasileira de Cardiologia. 7ª Diretriz Brasileira de Hipertensão arterial. SBC. 2016; 107(Suppl. 3): 91 pp.
25. NYHA - New York Heart Association. Nomenclature and criteria for diagnosis of disease of the heart and great vessels. 7th ed. Boston: Little and Brow Company; 1973.
26. Teicholz LE, Kreuler T, Werman MV. Problems in echocardiographic volume determinations: echocardiographic-angiocardiographic correlations in the presence or absence of asynergy. Am J Cardiol. 1976; 37: 7-12.
27. Amico AF, Lichtenberg GS, Reisner SA, Stone CK, Schwartz RG, Meltzer RS. Superiority of visual versus computerized echocardiographic estimation of radionuclide left ventricular ejection fraction. Am Heart Journal. 1989; 118: 1259-65.
28. Schiller NB, Shah PM, Crawtord M, DeMana A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocard. 1989; 2: 358-65.
29. Taleb MM. An infrequent cause of apical ventricular aneurysm in the United States. Heart views: the official journal of the Gulf Heart Association. 2017; 18(2): 54-7.
30. Carod-Artal FJ, Vargas AP, Horan TA, Nunes LGN. Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. Stroke. 2005; 36: 965-70.
31. Xavier SS. Longitudinal study of cardiac morbidity and mortality of Chagas disease in a cohort of a large urban center: clinical, electrocardiographic, radiological and echocardiographic analysis of 604 cases. [PhD Thesis in Medicine-Cardiology]. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 1999. 181 pp.
32. Cançado JR. Long term evaluation of etiological treatment of Chagas disease with benznidazole. Rev Inst Med Trop São Paulo. 2002; 44: 29-37.
33. Lana M, Lopes LA, Martins HR, Bahia MT, Machado-de-Assis GF, Wendling AP, et al. Clinical and laboratory status of patients with chronic Chagas disease living in a vector-controlled area in Minas Gerais, Brazil, before and nine years after aetiological treatment. Mem Inst Oswaldo Cruz. 2009; 104(8): 1139-47.
34. Zauza PL. Impact of repetitive treatment with benznidazol in humoral immune response, parasitaemia and cardiopathy in chronic chagasic patients of Virgem da Lapa, Vale do Jequitinhonha, Minas Gerais. [PhD Thesis in Tropical Medicine]. Rio de Janeiro: Fundação Oswaldo Cruz; 2016. 145 pp.

+ Corresponding author: borges@ioc.fiocruz.br / jborgespereira207@gmail.com
ORCID https://orcid.org/0000-0002-6153-5661
Received 05 February 2020
Accepted 22 May 2020

Our Location

Memórias do Instituto Oswaldo Cruz

Av. Brasil 4365, Castelo Mourisco 
sala 201, Manguinhos, 21040-900 
Rio de Janeiro, RJ, Brazil

Tel.: +55-21-2562-1222

This email address is being protected from spambots. You need JavaScript enabled to view it.

Support Program

ioc

fiocruz governo
faperj cnpq capes