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Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease
Francisco Javier Carod-Artal1, Antonio Pedro Vargas, Thomas Anthony Horan
1Department of Neurology, The Sarah Network of Hospitals of Rehabilitation, Sarah Hospital, Brasilia DF, Brazil. javier@bsb.sarah.br
Insights
Chagasic cardiomyopathy significantly increases ischemic stroke risk in Chagas disease patients. Hypercoagulable states are not major contributors to this increased risk.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Chagas disease (CD) is a significant public health issue in South America.
- Chagasic cardiomyopathy is a known complication of CD.
- Ischemic stroke is a serious concern in patients with Chagas disease.
Purpose of the Study:
- To evaluate the prevalence of vascular risk factors for stroke in patients with Chagas disease.
- To determine the association between Chagasic cardiomyopathy and ischemic stroke.
- To investigate the role of hypercoagulable states in stroke risk among CD patients.
Main Methods:
- A case-control study comparing 94 Chagasic stroke patients with 150 non-chagasic stroke patients.
- Chagas disease diagnosis confirmed by positive immunofluorescence and hemagglutination serology.
- Data collected included demographics, vascular risk factors, stroke subtype (TOAST), echocardiography, and thrombophilia markers.
Main Results:
- Chagasic stroke patients were younger (mean age 56.31 vs 61.59 years).
- Cardioembolism was more frequent in CD stroke patients (56.38% vs 9.33%).
- Apical aneurysm, left ventricular dilatation, and abnormal ECG were significantly higher in CD stroke patients.
Conclusions:
- Chagasic cardiomyopathy is independently associated with an increased risk of ischemic stroke.
- Hypercoagulable states do not appear to be a primary driver of excess stroke risk in Chagas disease.
- Identifying cardiac abnormalities is crucial for stroke prevention in CD patients.
Background And Purpose:
Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. American trypanosomiasis, Chagas disease (CD), is a major public health problem in South America. We sought to evaluate prevalence of vascular risk factors for stroke in patients with stroke caused by CD.
Methods:
Ninety-four consecutive CD stroke patients and 150 consecutive nonchagasic stroke patients were studied. CD was confirmed when both immunofluorescence and hemagglutination serology were positive. Data collected included age, sex, vascular risk factors, diagnostic stroke subtype (TOAST classification), and echocardiography findings. Fasting plasma levels of protein C, protein S, antithrombin III, homocysteine, activated protein C resistance, IgG anticardiolipin antibodies, lupus anticoagulant, and genetic tests for the factor V Leiden and the C677T methylene tetrahydrofolate reductase gene mutation were determined.
Results:
CD patients had a mean age of 56.31 years compared with 61.59 years for non-CD stroke patients (P=0.0002). Cardioembolism occurred in 56.38% of CD stroke patients compared with 9.33% in controls (P=0.000), whereas atherothrombotic strokes occurred in 8.51% of CD strokes versus 20% in controls (P=0.016), and small-vessel stroke in 9.57% of CD stroke patients versus 34.67% in controls (P=0.000). Apical aneurysm (37.23% versus 0.67%; OR, 88.39), left ventricular dilatation (23.4% versus 5.33%; OR, 5.42), mural thrombus (11.7 versus 2%; OR, 6.49) and abnormal electrocardiography (ECG) (66% versus 23.33%; OR, 2.87) were significantly higher in the group of chagasic stroke patients. No statistical differences were observed in thrombophilia between both groups. The significant variables that predicted CD stroke patients on a stepwise logistical regression model were apical aneurysm, cardiac insufficiency, ECG arrhythmia, female gender, and hypertension.
Conclusions:
Chagasic cardiomyopathy is independently associated with ischemic stroke, whereas hypercoagulable states do not appear to be major contributors to the excess stroke risk seen in patients with CD.
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