Clinical characteristics and outcome of 107 adult patients with chronic Chagas disease and parasitological cure criteria.

BACKGROUND: The cure in adult patients with chronic Chagas disease and the relationship between parasitological and clinical evolution is still under debate. The aim of this study was to analyze the clinical, epidemiological and progression features of the disease in a patient population who became serologically negative either spontaneously or post-etiological treatment. METHODS: We included 107 patients over 20 years old with three different confirmed reactive anti-Trypanosoma cruzi serologic tests on admission, and a minimum of two years of follow-up. Patients were assigned to clinical groups according to Kuschnir. Change of clinical group was considered a heart disease progression criterion, and seronegative conversion of two or three as parasitological cure criterion. RESULTS: From 107 patients with parasitological cure, 82 had received treatment (77%) and 25 became spontaneously seronegative (23%). Forty-six (43%) and 61 (57%) patients had two and three negative serological tests, respectively. No differences in clinical groups, ECG, echocardiogram and heart disease progression were found in patients who became negative spontaneously or post-treatment. The clinical progression and ECG changes were observed in 5/107 (5%) and 11/107 (10%) respectively, in a mean of 10 years follow-up. CONCLUSIONS: Adults with chronic Chagas disease can cure, mostly post-etiological treatment, but also spontaneously, showing a favourable clinical outcome.

The impact of socioeconomic conditions on chronic Chagas disease progression.

INTRODUCTION AND OBJECTIVES: The extent to which a patient's socioeconomic conditions determine the persistence or control of chronic Chagas disease has not been previously investigated. The aim of this study was to evaluate the effect of socioeconomic conditions on clinical and serologic measures of disease progression. METHODS: Data on the following socioeconomic variables were obtained by questioning as part of medical history taking at admission: birth in a rural area, time of residence in endemic and urban areas (in years), overcrowding index (i.e. number of inhabitants/number of bedrooms), absence of toilet facilities, years of education, employed or unemployed, and health insurance coverage (i.e. private contributory medical insurance cover). The study endpoints for the Cox regression analysis were: consistently negative results on serologic tests and on tests for markers of cardiomyopathy progression by the end of the study. RESULTS: The study included 801 Argentine patients (mean age 42 years) who were followed up for a mean of 10 years between 1990 and 2005. After adjustment for age and antiparasitic treatment, negative seroconversion was associated with a short time of residence in an endemic area (hazard ratio [HR]=0.97; 95% confidence interval [CI], 0.96-0.99; P=.004), a low overcrowding index (HR=0.82; 95% CI, 0.70-0.97; P=.022) and medical insurance cover (HR=1.46; 95% CI, 1.01-2.09; P=.04). After adjustment for age, sex, ECG abnormalities and antiparasitic treatment, a low rate of cardiomyopathy progression was associated with more years of education (HR=0.88; 95% CI, 0.80-0.97; P=.01) and higher medical insurance cover (HR=0.49; 95% CI, 0.30-0.81; P=.005). CONCLUSIONS: Socioeconomic conditions had a significant effect on chronic Chagas disease progression which was independent of antiparasitic treatment and clinic characteristics.

El impacto de las condiciones socioeconómicas en la evolución de la enfermedad de Chagas crónica / The impact of socioeconomic conditions on chronic Chagas disease progression

Introducción y objetivos. Las condiciones socioeconómicas del huésped no han sido evaluadas como determinantes de la persistencia o el control de la enfermedad de Chagas crónica. El objetivo fue valorar el impacto de las condiciones socioeconómicas sobre la evolución clínica y serológica. Métodos. Las variables socioeconómicas en estudio fueron obtenidas por interrogatorio como parte de la historia clínica de ingreso: nacimiento en área rural, tiempo de residencia en área endémica y urbana (años), índice de hacinamiento (número de habitantes/número de dormitorios), ausencia de instalaciones sanitarias, años de educación, ocupación/desocupación y cobertura social (planes de asistencia médica por aportación privada). La negativización de las pruebas serológicas y los indicadores de progresión de la cardiopatía al concluir el estudio fueron los puntos finales de evaluación para el análisis de regresión de Cox. Resultados. Se incluyó a 801 pacientes, de 42 años de edad y 10 años de seguimiento promedio, en Argentina, entre los años 1990 y 2005. Un aumento de la seroconversión negativa, ajustada para edad y tratamiento etiológico, se asoció con un menor tiempo de residencia en área endémica (hazard ratio [HR] = 0,97 [0,96-0,99]; p = 0,004), menor índice de hacinamiento (HR = 0,82 [0,70-0,97]; p = 0,022) y mayor cobertura social (HR = 1,46 [1,01-2,09]; p = 0,04). Una disminución de la progresión de la cardiopatía, ajustada para edad, sexo, electrocardiograma anormal y tratamiento etiológico, se observó en pacientes con más años de educación (HR = 0,88 [0,80-0,97]; p = 0,01) y con cobertura social (HR = 0,49 [0,30-0,81]; p = 0,005). Conclusiones. Las condiciones socioeconómicas mostraron un significativo impacto sobre la evolución de la enfermedad de Chagas crónica independientemente del tratamiento antiparasitario y las características clínicas (AU)

Introduction and objectives. The extent to which a patient’s socioeconomic conditions determine the persistence or control of chronic Chagas disease has not been previously investigated. The aim of this study was to evaluate the effect of socioeconomic conditions on clinical and serologic measures of disease progression. Methods. Data on the following socioeconomic variables were obtained by questioning as part of medical history taking at admission: birth in a rural area, time of residence in endemic and urban areas (in years), overcrowding index (ie, number of inhabitants/number of bedrooms), absence of toilet facilities, years of education, employed or unemployed, and health insurance coverage (ie, private contributory medical insurance cover). The study endpoints for the Cox regression analysis were consistently negative results on serologic tests and on tests for markers of cardiomyopathy progression by the end of the study. Results. The study included 801 Argentine patients (mean age, 42 years) who were followed up for a mean of 10 years between 1990 and 2005. After adjustment for age and antiparasitic treatment, negative seroconversion was associated with a short time of residence in an endemic area (hazard ratio [HR] = 0.97; 95% confidence interval [CI], 0.96-0.99; P=.004), a low overcrowding index (HR=0.82; 95% CI, 0.70-0.97; P=.022) and medical insurance cover (HR=1.46; 95% CI, 1.01-2.09; P=.04). After adjustment for age, sex, ECG abnormalities, and antiparasitic treatment, a low rate of cardiomyopathy progression was associated with more years of education (HR=0.88; 95% CI, 0.80-0.97;P=.01) and higher medical insurance cover (HR=0.49; 95% CI, 0.30-0.81; P=.005). Conclusions. Socioeconomic conditions had a significant effect on chronic Chagas disease progression which was independent of antiparasitic treatment and clinic characteristics (AU)

[Predictors of heart failure in chronic chagasic cardiomyopathy with asymptomatic left ventricular dysfunction]. / Predictores de insuficiencia cardiaca en la miocardiopatía chagásica crónica con disfunción asintomática del ventrículo izquierdo.

INTRODUCTION AND OBJECTIVES: The development of asymptomatic left ventricular dysfunction signifies a worsening of chronic chagasic cardiomyopathy. Our objective was to identify factors that predict the development of heart failure and all-cause mortality. METHODS: The study included 95 patients with an echocardiographic diagnosis of asymptomatic left ventricular dysfunction. The patients' clinical, electrocardiographic and echocardiographic characteristics were recorded. Factors associated with the development of heart failure were evaluated by Cox regression modeling. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of continuous variables identified as significant in the regression analysis. RESULTS: Patients (mean age, 55 [11] years) were followed up for a median of 63 months (interquartile range, 32-110 months). Univariate analysis showed that there were significant differences in mild and severe systolic dysfunction, age on admission, and E-point-to-septal separation, while the only significant predictors of heart failure found on Cox regression analysis were severe systolic dysfunction (HR=3.53; 95% CI, 1.21-10.30; P=.021) and E-point-to-septal separation (HR=1.12; 95% CI, 1.02-1.23; P=.014). The mortality rate was 3% (3/95) in patients who continued to have asymptomatic left ventricular dysfunction and 37% (10/27) in those who developed heart failure. CONCLUSIONS: The E-point-to-septal separation and the presence of severe systolic dysfunction can serve as predictors of heart failure in patients with chronic chagasic cardiomyopathy and asymptomatic left ventricular dysfunction.

Predictores de insuficiencia cardiaca en la miocardiopatía chagásica crónica con disfunción asintomática del ventrículo izquierdo / Predictors of heart failure in chronic chagasic cardiomyopathy with asymptomatic left ventricular dysfunction

Introducción y objetivos. La disfunción ventricular izquierda asintomática representa un estadio de mala evolución en la miocardiopatía chagásica crónica. Nuestro objetivo fue establecer los posibles predictores de progresión hacia la insuficiencia cardiaca y mortalidad total. Métodos. Se incluyó a 95 pacientes con diagnóstico ecocardiográfico de disfunción ventricular izquierda asintomática. Las variables estudiadas fueron clínicas, electrocardiográficas y ecocardiográficas. Para evaluar la progresión hacia la insuficiencia cardiaca se utilizó un modelo de regresión de Cox. Se calcularon las hazard ratio (HR) y sus intervalos de confianza del 95%. La curva receiver operating characteristic (ROC) se utilizó para valorar la sensibilidad y la especificidad de las variables continuas con significación en la regresión. Resultados. El tiempo de seguimiento presentó una mediana de 63 meses y un rango intercuartílico de 32-110 meses, con una edad promedio de 55 ± 11 años. El deterioro leve y severo de la función sistólica, la edad al ingreso y la distancia E-septum mostraron diferencias significativas en el análisis univariable, mientras que la disfunción sistólica severa (p = 0,021; HR = 3,53 [1,21-10,3]) y la distancia E-septum (p = 0,014; HR = 1,12 [1,02-1,23]) fueron las únicas variables predictoras de insuficiencia cardiaca en el análisis de regresión de Cox. La mortalidad fue del 3% (3/95) de los pacientes que permanecieron con disfunción ventricular izquierda asintomática y el 37% (10/27) de los pacientes que evolucionaron hacia la insuficiencia cardiaca. Conclusiones. La distancia E-septum y el deterioro severo de la función sistólica pueden ser predictores de insuficiencia cardiaca en pacientes con miocardiopatía chagásica crónica y disfunción ventricular izquierda asintomática (AU)

Introduction and objectives. The development of asymptomatic left ventricular dysfunction signifies a worsening of chronic chagasic cardiomyopathy. Our objective was to identify factors that predict the development of heart failure and all-cause mortality. Methods. The study included 95 patients with an echocardiographic diagnosis of asymptomatic left ventricular dysfunction. The patients' clinical, electrocardiographic and echocardiographic characteristics were recorded. Factors associated with the development of heart failure were evaluated by Cox regression modeling. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of continuous variables identified as significant in the regression analysis. Results. Patients (mean age, 55 [11] years) were followed up for a median of 63 months (interquartile range, 32­110 months). Univariate analysis showed that there were significant differences in mild and severe systolic dysfunction, age on admission, and E-point-to-septal separation, while the only significant predictors of heart failure found on Cox regression analysis were severe systolic dysfunction (HR=3.53; 95% CI, 1.21­10.30; P=.021) and E-point-to-septal separation (HR=1.12; 95% CI, 1.02­1.23; P=.014). The mortality rate was 3% (3/95) in patients who continued to have asymptomatic left ventricular dysfunction and 37% (10/27) in those who developed heart failure. Conclusions. The E-point-to-septal separation and the presence of severe systolic dysfunction can serve as predictors of heart failure in patients with chronic chagasic cardiomyopathy and asymptomatic left ventricular dysfunction (AU)