Abstract
Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic events. Of all thromboembolic events, stroke is the most feared, due to the high probability of evolution to death or disability. Despite its importance, the actual incidence of cardioembolic ischemic stroke in Chagas disease is not completely known. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC-FIOCRUZ) score aims to propose prophylaxis strategies against cardioembolic ischemic stroke in Chagas disease based on clinical risk–benefit. To date, the IPEC-FIOCRUZ score is considered the best tool to identify patients for stroke prophylaxis in Chagas disease according the Latin American guideline and Brazilian consensus. It can prevent many cardioembolic strokes that would not be predicted, by applying the current recommendations to other cardiopathies. However, the IPEC-FIOCRUZ score still requires external validation to be used in different Chagas disease populations with an appropriate study design.
Highlights
Chagas disease (CD) is an important protozoan infection in Latin America where it remains one of the most important public health problems due to the high morbidity and mortality associated with the chronic cardiac form of the disease [1]
Chagasic cardiopathy has unique characteristics such as apical aneurism, an important risk factor for cardioembolic events [6], which can limit the efficacy of prophylaxis in cardioembolic ischemic stroke (CIS)
The IPEC-FIOCRUZ score was built to fulfill the lack of knowledge of the individual risk–benefit of prophylaxis for cardioembolic stroke in the Chagas cardiopathy population not covered by the available scores
Summary
Chagas disease (CD) is an important protozoan infection in Latin America where it remains one of the most important public health problems due to the high morbidity and mortality associated with the chronic cardiac form of the disease [1]. Thromboembolic events in Chagas heart disease are more frequent than in other cardiopathies, even with similar degrees of systolic dysfunction [5], inferring that chagasic cardiopathy has a higher emboligenic potential. A much higher frequency of chagasic stroke in patients without vascular risk factors is observed when compared to the non-Chagas cohort [6]. One study estimated that the annual incidence of CIS in a cohort of patients with CD was 3% in all subjects, and 4.4% in the high-risk subgroup, with a mean follow-up period of 5.5 years [8]. It is fundamental to identify strategies to prevent these events in patients with CD
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