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Chagas disease stroke and associated risk factors: A case-control study
Eduardo Sousa de Melo1, Rodrigo de Paiva Bezerra2, Arthur Cesário de Holanda1
1Hospital das Clínicas, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, PE, Brazil.
Insights
Cardiac issues are the main drivers of ischemic stroke in Chagas disease patients. Atherosclerosis risk factors play a lesser role, highlighting the need for cardiac monitoring in Chagas disease management.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- The link between Chagas disease and ischemic stroke is not well understood.
- Limited data exists on secondary stroke prevention and risk factors in Chagas disease patients.
Purpose of the Study:
- To identify factors associated with ischemic stroke in patients with Chagas disease.
- To compare stroke risk factors between Chagas disease patients with and without a history of ischemic stroke.
Main Methods:
- Retrospective analysis of outpatient Chagas disease patients from two Brazilian hospitals.
- Descriptive statistics and logistic regression to identify stroke-associated factors.
Main Results:
- Of 678 subjects, 72 experienced stroke.
- Independent predictors of stroke included congestive heart failure, right bundle branch block, left anterosuperior divisional block, and atrial fibrillation.
- Cardiac involvement was the primary factor associated with stroke.
Conclusions:
- Cardiac abnormalities are the main correlate of stroke in Chagas disease.
- Atherosclerosis-related risk factors had a limited impact on ischemic stroke risk in this population.
Introduction:
The intricate relationship between Chagas disease and ischemic stroke remains unclear. Limited evidence exists concerning secondary prophylaxis, etiological diagnosis, and stroke-related determinants. This study aims to discern factors linked to stroke in Chagas disease by contrasting patients with and without a history of ischemic stroke.
Methods:
Retrospective data from all outpatient Chagas disease patients from two Brazilian hospitals - one Chagas center and one stroke clinic - were examined. Descriptive analyses were conducted to identify stroke-associated factors. Variables were compared between patients with and without ischemic stroke history.
Results:
Among 678 subjects, 72 had experienced stroke. Univariate associations with stroke included male gender, heart failure, prior or ongoing alcoholism, electrocardiographic features (non-sinus rhythm, left bundle branch, right bundle branch block, left anterosuperior fascicular block, atrial fibrillation), as well as echocardiographic findings indicative of reduced left ventricular ejection fraction and segmental abnormalities. After logistic regression (multivariate analysis), congestive heart failure, right bundle branch block, left anterosuperior divisional block, and atrial fibrillation retained independent associations.
Conclusion:
In this study, cardiac involvement emerged as the predominant factor correlated with stroke in Chagas disease. While atherosclerosis-related risk factors were prevalent, their influence on ischemic stroke in Chagas disease appeared limited.
