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Electrocardiogram and Chagas disease: a large population database of primary care patients
Milena S Marcolino1, Daniel M Palhares1, Lorena R Ferreira1
1Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Insights
Electrocardiographic abnormalities are highly prevalent in Chagas disease (ChD) patients, with pacemaker rhythm and specific heart blocks strongly associated with the condition. Early detection through ECG is crucial for managing ChD complications.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Chagas disease (ChD) is a global health concern due to migration, extending beyond its traditional Latin American endemicity.
- Electrocardiography (ECG) is a vital diagnostic tool for assessing ChD patients.
Purpose of the Study:
- To determine the prevalence of electrocardiographic abnormalities in a large Chagas disease patient cohort within a primary care setting.
- To identify specific ECG findings strongly associated with Chagas disease.
Main Methods:
- A retrospective observational study analyzed digital 12-lead ECGs from primary care patients in Minas Gerais, Brazil (2011).
- Chagas disease status was self-reported; individuals without self-reported ChD served as the noninfected control group.
- Prevalence of ECG abnormalities was calculated and compared between infected and noninfected individuals.
Main Results:
- Chagas disease patients (7,590) represented 2.9% of the total ECGs analyzed (264,324).
- Common ECG abnormalities included nonspecific repolarization abnormalities (34.6%), right bundle branch block (RBBB) (22.7%), and left anterior hemiblock (LAH) (22.5%).
- ChD patients exhibited significantly lower rates of normal ECGs (31.5%) compared to noninfected individuals (61.2%).
- Pacemaker rhythm, RBBB (especially with LAH), and second/third-degree atrioventricular blocks showed strong associations with ChD.
Conclusions:
- A high prevalence of electrocardiographic abnormalities exists in primary care patients with Chagas disease.
- Specific ECG findings, including pacemaker rhythm, RBBB with LAH, and atrioventricular blocks, are significantly linked to ChD.
Background:
Chagas disease (ChD) used to be a disease restricted to Latin America, but has become a worldwide problem due to migration of infected individuals to developed countries. Electrocardiography has been considered an essential exam to evaluate ChD patients.
Objective:
This study sought to identify prevalent electrocardiographic abnormalities in a large sample of ChD patients evaluated in the primary care setting.
Methods:
This retrospective observational study assessed all consecutive digital 12-lead electrocardiograms (ECG) performed by the Telehealth Network of Minas Gerais, Brazil, from January 1 to December 31, 2011. In that time, the service attended primary care patients in 660 cities in the Minas Gerais province. ChD was self-reported, and the individuals who did not report having ChD were considered noninfected. The prevalence of electrocardiographic abnormalities was assessed.
Results:
Self-reported ChD patients comprised 7,590 (2.9%) of 264,324 patients who underwent ECG during the study period. The mean age for ChD patients was 57.0 ± 13.7 years, and 64.1% of patients were women. The most common comorbidities were hypertension (61.3%), diabetes (9.1%), and dyslipidemia (6.9%), and 10.7% were smokers. The most frequent electrocardiographic abnormalities were nonspecific repolarization abnormalities (34.6%), right bundle branch block (RBBB) (22.7%), left anterior hemiblock (LAH) (22.5%), ventricular premature beats (5.4%), and atrial fibrillation (5.4%). Only 31.5% of the patients had no electrocardiographic abnormality versus 61.2% in noninfected individuals (p < 0.001). The prevalence of normal ECG decreased with aging and was significantly lower than for noninfected individuals in all age groups. Pacemaker rhythm (odds ratio [OR]: 13.3, 95% confidence intervals [CI]: 11.5 to 15.4), RBBB (OR: 10.7, 95% CI: 10.1 to 11.4), especially in association with LAH (OR: 12.1, 95% CI: 11.2 to 13.0), second atrioventricular block (OR: 4.1, 95% CI: 2.5 to 6.6), and third atrioventricular block (OR: 13.3, 95% CI: 11.5 to 15.4) were strongly related to ChD.
Conclusions:
In this large sample of primary care patients with ChD, there was a high prevalence of electrocardiographic abnormalities. Pacemaker rhythm, RBBB, especially in association with LAH, and second and third atrioventricular block were strongly related to ChD.
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