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Cardioembolic stroke in Chagas cardiomyopathy: the interplay between apical aneurysm, left ventricular thrombus and

Julia Teixeira Tupinambás1, Manoel Otavio C Rocha1,2, Thais Aparecida R Lage1

  • 1Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Heart (British Cardiac Society)
|July 28, 2026
PubMed

Insights

In Chagas cardiomyopathy (CCM), apical aneurysms increase stroke risk primarily through left ventricular thrombus formation. Prior cardioembolic stroke indicates a higher risk of recurrence, guiding targeted prevention strategies.

Area of Science:

  • Cardiology
  • Neurology
  • Infectious Diseases

Background:

  • Apical aneurysm is a known complication of Chagas cardiomyopathy (CCM).
  • The independent contribution of apical aneurysm to cardioembolic (CE) stroke and its underlying mechanisms in CCM are not fully understood.
  • Understanding these associations is crucial for effective stroke prevention in CCM patients.

Purpose of the Study:

  • To evaluate the association between apical aneurysm and CE stroke in patients with CCM.
  • To assess the prognostic implications of CE stroke in this population.
  • To elucidate the mechanisms linking apical aneurysm to CE stroke.

Main Methods:

  • Prospective cohort study of 518 CCM patients.
  • Baseline assessments included clinical, electrocardiographic, and echocardiographic evaluations.
  • Logistic regression, genetic matching, and causal mediation analyses were used to assess stroke associations and the role of left ventricular (LV) thrombus.

Main Results:

  • Apical aneurysm was significantly associated with CE stroke when using genetic matching, with 63.3% of this association mediated by LV thrombus.
  • Prior CE stroke and LV thrombus were independent predictors of prior CE stroke.
  • Neither prior CE stroke nor apical aneurysm predicted mortality or heart transplantation, but incident CE stroke was linked to prior CE stroke and LV thrombus.

Conclusions:

  • Cardioembolic stroke in CCM is predominantly driven by LV thrombus formation.
  • Apical aneurysm contributes to embolic risk primarily by promoting thrombus formation.
  • Identifying LV thrombus and implementing anticoagulation are key for targeted stroke prevention in CCM.
Abstract

Keywords:
Chagas DiseaseEchocardiographyStroke

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