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Chagas' heart disease in the United States
1Department of Medicine, University of Southern California Medical Center, Los Angeles.
Insights
Chagas' heart disease, often misdiagnosed as coronary artery disease in the US, has a poor prognosis, especially with heart failure or left ventricular dysfunction. Early diagnosis is crucial for better outcomes in this underrecognized condition.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Chagas' heart disease is prevalent in endemic countries but considered rare in the US.
- A significant population from endemic regions resides in the US, suggesting potential underdiagnosis.
- The clinical presentation can mimic other common cardiac conditions.
Purpose of the Study:
- To investigate the characteristics and outcomes of Chagas' heart disease in a US patient cohort.
- To determine the diagnostic challenges and prognostic factors associated with Chagas' heart disease.
- To highlight the potential for underdiagnosis in the United States.
Main Methods:
- Retrospective case review and prospective follow-up of 25 patients.
- Analysis of clinical presentation, diagnostic tests (including angiography, electrocardiograms, and thallium scans), and programmed ventricular stimulation.
- Assessment of survival rates and predictors of mortality.
Main Results:
- Patients presented with various arrhythmias, heart failure, and chest pain, often mimicking coronary artery disease.
- Left ventricular aneurysms and dysfunction were common (14/25 and 5/25 respectively).
- Four-year survival was significantly lower for patients with left ventricular dysfunction or aneurysm (45% vs. 100%), with heart failure and these structural abnormalities being independent predictors of death.
Conclusions:
- Chagas' heart disease frequently mimics coronary artery disease and idiopathic dilated cardiomyopathy in the US.
- Prognosis is poor for patients with heart failure or left ventricular dysfunction/aneurysm.
- The disease is likely underdiagnosed in the United States, necessitating increased awareness.
Background And Methods:
Chagas' heart disease is believed to be rare in the United States, although many persons from countries where the disease is endemic reside here. We performed a retrospective case review and prospective follow-up of 25 patients with Chagas' heart disease and no obstructive coronary artery disease on angiography.
Results:
The patients mainly presented with symptomatic atrioventricular block, congestive heart failure, anginal chest pain, sudden death averted by resuscitation, or sustained ventricular tachycardia. Of the 25 patients, 18 had been treated for coronary artery disease or idiopathic dilated cardiomyopathy for up to 108 months before the diagnosis of Chagas' disease was considered. The electrocardiograms frequently suggested coronary artery disease. Six of the seven patients who had exercise thallium-perfusion scans had abnormalities suggesting ischemia or infarction. A left ventricular aneurysm was found in 14 of the 25 patients, segmental akinesia or hypokinesia in 5, and diffuse hypokinesia in 3. Programmed ventricular stimulation performed in 13 patients induced sustained ventricular tachycardia in 9 and nonsustained ventricular tachycardia in 2. Actuarial survival (mean +/- SE) after four years for the entire group was 56 +/- 12 percent; it was 32 +/- 16 percent among those with global left ventricular dysfunction, and 78 +/- 14 percent among those without such dysfunction (P = 0.03). Only patients with left ventricular dysfunction or an aneurysm died (four-year survival, 45 +/- 14 percent, as compared with 100 percent for the remaining patients; P = 0.0002). Heart failure and left ventricular aneurysm or dysfunction were the only independent predictors of death. Nine patients required permanent pacemakers.
Conclusions:
In the United States, Chagas' heart disease commonly mimics coronary artery disease or idiopathic dilated cardiomyopathy. The prognosis is poor for patients with heart failure or left ventricular aneurysm or dysfunction. The disease may be underdiagnosed in the United States.