Myocardial Injury in Patients With Acute and Subacute Chagas Disease in the Brazilian Amazon Using Cardiovascular
Katia do Nascimento Couceiro1, Jessica Vanina Ortiz1,2, Mônica Regina Hosannah da Silva E Silva1
1Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil.
Insights
This study shows that cardiovascular magnetic resonance imaging can detect myocardial injury in acute Chagas disease patients. Early detection and follow-up are crucial for managing cardiac impairment in Chagas disease.
Area of Science:
- Cardiology
- Infectious Diseases
- Tropical Medicine
Background:
- Chagas disease is a neglected tropical disease and a global health emergency.
- Oral transmission leading to acute cases is common in the Amazon region.
- Cardiac involvement is a significant concern in Chagas disease progression.
Purpose of the Study:
- To evaluate myocardial injury in patients with acute Chagas disease.
- To assess cardiac changes before and after treatment using advanced imaging.
- To establish the role of cardiovascular magnetic resonance imaging in early diagnosis.
Main Methods:
- Evaluated 23 patients with acute Chagas disease in acute and late post-acute phases.
- Utilized electrocardiograms (ECG) with Selvester score and 24-hour Holter monitoring.
- Performed cardiovascular magnetic resonance imaging (CMR) to assess myocardial injury.
Main Results:
- Myocardial injury was detected in 58.3% of patients during the acute phase via CMR.
- ECG alterations, including left anterior fascicular block, were common (69.6%).
- Cardiac abnormalities persisted or were identified in follow-up assessments.
Conclusions:
- This study is the first to demonstrate myocardial injury using CMR in acute Chagas disease.
- CMR is a valuable tool for detecting cardiac impairment in early Chagas disease.
- Emphasizes the importance of early detection and cardiac follow-up for Chagas disease patients.
Abstract:
Background Chagas disease is a neglected tropical disease that is still considered a global health emergency. In the Amazon region, most of the reports are of acute cases that are associated with oral transmission. This study aimed to evaluate myocardial injury in patients with acute Chagas disease before and after treatment. Methods and Results We evaluated 23 patients with acute Chagas disease in 3 different stages of progression. Group 1 had 12 patients evaluated during the acute phase, at the time of diagnosis, and 1 year after treatment, and Group 2 had 11 patients in the late postacute phase who were evaluated 5.2 years on average after diagnosis and treatment. ECGs with the Selvester score, 24-hour Holter exam, and cardiovascular magnetic resonance imaging were performed. The mean age of the 23 patients was 44.3±18.9 years, and they were mostly men (15/65.24%) from Amazonas state (22/95.6%). In 69.6% (n=16) of the patients, some ECG alterations were found, the most frequent being left anterior fascicular block and ventricular repolarization. In Group 1, the 24-hour Holter exam showed atrial tachycardia in 3 (25%) patients and ventricular extrasystoles in 2 (16.7%) patients. In Group 2, 1 patient had ventricular extrasystoles. Myocardial injury was observed in 7 patients (58.3%) at the acute phase and in 5 (50%) patients at the 1-year follow-up in Group 1 and in 2 (18.2%) patients in Group 2. Conclusions This article describes, for the first time, myocardial injury shown by cardiovascular magnetic resonance imaging in a group of patients with acute Chagas disease and reveals the importance of early detection and follow-up of the cardiac impairment in these patients.
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