Abstract
BackgroundAging and migration have brought changes to the epidemiology and stroke has been shown to be independently associated with Chagas disease. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology.Methodology/Principal FindingsWe performed a cross-sectional review of medical records of 790 patients with a cardiomyopathy. Patients with chagasic (329) and non-chagasic (461) cardiomyopathies were compared. There were 108 stroke cases, significantly more frequent in the Chagas group (17.3% versus 11.1%; p<0.01). Chagasic etiology (odds ratio [OR], 1.79), pacemaker (OR, 2.49), atrial fibrillation (OR, 3.03) and coronary artery disease (OR, 1.92) were stroke predictors in a multivariable analysis of the entire cohort. In a second step, the population was split into those with or without a Chagas-related cardiomyopathy. Univariable post-stratification stroke predictors in the Chagas cohort were pacemaker (OR, 2.73), and coronary artery disease (CAD) (OR, 2.58); while atrial fibrillation (OR, 2.98), age over 55 (OR, 2.92), hypertension (OR, 2.62) and coronary artery disease (OR, 1.94) did so in the non-Chagas cohort. Chagasic stroke patients presented a very high frequency of individuals without any vascular risk factors (40.4%; OR, 4.8). In a post-stratification logistic regression model, stroke remained associated with pacemaker (OR, 2.72) and coronary artery disease (OR, 2.60) in 322 chagasic patients, and with age over 55 (OR, 2.38), atrial fibrillation (OR 3.25) and hypertension (OR 2.12; p = 0.052) in 444 non-chagasic patients.Conclusions/SignificanceChagas cardiomyopathy presented both a higher frequency of stroke and an independent association with it. There was a high frequency of strokes without any vascular risk factors in the Chagas as opposed to the non-Chagas cohort. Pacemaker rhythm and CAD were independently associated with stroke in the Chagas group while age over 55 years, hypertension and atrial fibrillation did so in the non-Chagas cardiomyopathies.
Highlights
Chagas disease (CD) is caused by the flagellate protozoan Trypanosoma cruzi and its main mechanism of transmission is transcutaneous inoculation of the parasite by excreta of infected insects [1,2,3]
The purpose of this study was to describe the frequency of stroke correlates in a population presenting with a cardiomyopathy, representative of a tertiary center in northeastern Brazil with a specific focus on the chagasic etiology to define its clinical profile according to stroke risk
Chagas disease and its related cardiomyopathy have long been associated with thrombo-embolism and stroke in necropsy studies [20,35,36]
Summary
Chagas disease (CD) is caused by the flagellate protozoan Trypanosoma cruzi and its main mechanism of transmission is transcutaneous inoculation of the parasite by excreta of infected insects [1,2,3]. In non-endemic countries, blood transfusion, organ transplantation, and vertical transmission are more likely routes of infection [1,3,4,5,6]. Vector transmission has been virtually interrupted in most endemic countries [9], non-permanent sanitation control [9,14,15], alternative transmission routes [7,8], escalating migration [4,12], and the increase in life expectancy have resulted in a pressing pattern of Chagas cardiomyopathy on the overall burden of chronic disease [4,16,17,18]. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology
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