Abstract
An ever-increasing number of patients with chronic indeterminate Chagas disease are diagnosed with early vascular and cardiac abnormalities, as cardiovascular imaging becomes more sensitive. However, the currently available information on aortic stiffness (a prognostic marker for adverse cardiovascular outcomes) in these patients is scarce. In this study, we consecutively recruited 21 asymptomatic Bolivian adult patients with chronic indeterminate Chagas disease and 14 Bolivian adults, who were seronegative for Trypanosoma cruzi infection. No participants had a prior history of heart disease, hypertension, diabetes, chronic kidney disease or atrial fibrillation. Carotid-femoral pulse wave velocity (cf-PWV), carotid-radial PWV (cr-PWV), carotid intima-media thickness and conventional echocardiographic measurements were recorded in all participants. Patients with chronic indeterminate Chagas disease had significantly higher cf-PWV (7.9±1.3 vs. 6.4±1.1 m/s, p = 0.003) and greater HOMA-estimated insulin resistance than subjects without Chagas disease. The two groups did not significantly differ in terms of age, sex, smoking, adiposity measures, blood pressure, plasma lipids, fasting glucose levels as well as cr-PWV, carotid intima-media thickness measurements, left ventricular mass and function. Presence of chronic indeterminate Chagas disease was significantly associated with increasing cf-PWV values (β coefficient: 1.31, 95% coefficient interval 0.44 to 2.18, p = 0.005), even after adjustment for age, sex, heart rate, systolic blood pressure and insulin resistance. In conclusion, asymptomatic Bolivian adult patients with chronic indeterminate Chagas disease have an early and marked increase in aortic stiffness, as measured by cf-PWV, when compared to Bolivian adults who were seronegative for Trypanosoma cruzi infection.
Highlights
Chagas disease is regarded as a neglected tropical disease, and is a zoonosis from the Latin America, which is caused by the protozoan parasite Trypanosoma cruzi [1]
Given that Bolivian immigrants are at high risk of Chagas disease and represent one of the largest Latin American communities in Northern Italy today [4], we sought to examine whether Bolivian adult patients in the indeterminate phase of chronic Chagas disease have an increased aortic stiffness, as measured by carotid-femoral pulse wave velocity (cf-PWV), when compared to Bolivian adults, who were seronegative for T. cruzi infection
The main finding of our pilot study was that asymptomatic Bolivian adult patients with chronic indeterminate Chagas disease had remarkably higher values of cf-PWV, a greater prevalence of those with cf-PWV >10 m/s and greater insulin resistance compared with Bolivian adults, who were seronegative for T. cruzi infection
Summary
Chagas disease is regarded as a neglected tropical disease, and is a zoonosis from the Latin America, which is caused by the protozoan parasite Trypanosoma cruzi [1]. As a consequence of migrations from Latin America, a globalization of the disease is under way, and there are currently thousands of infected Latin Americans living in Europe [2,3,4]. The prevalence of T. cruzi infection in Latin American migrants, living in Europe and Italy, is estimated to be nearly 4–5%, with the highest prevalence among migrants from Bolivia [3,4]. Most infected persons remain for life in the indeterminate phase of chronic Chagas disease, which is characterized by subpatent parasitemia, seropositivity for T. cruzi, absence of clinical signs and symptoms of cardiac and digestive involvement, and normal chest radiography and electrocardiography [1,5]. Increasingly more patients with chronic indeterminate Chagas disease are diagnosed with subtle vascular and cardiac abnormalities (as diagnostic methods become more sensitive for detecting the cardiovascular involvement in these patients) [6], but the prognostic value of such abnormalities remains unclear
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