Relationship of electrocardiographic abnormalities and seropositivity to Trypanosoma cruzi within a rural community in Northeast Brazil

doi:10.1016/0002-8703(83)90529-X

American Heart Journal

Volume 105, Issue 2, February 1983, Pages 287-294

https://doi.org/10.1016/0002-8703(83)90529-X Get rights and content

Abstract

The relationship of infection with Trypanosoma cruzi to ECG abnormalities was studied in a defined population in rural Bahia, Brazil. Of 644 individuals 10 years of age or older who had complement fixation tests for antibodies to T. cruzi and ECGs, 53.7% were seropositive. ECG abnormalities were more common in seropositive individuals than in seronegative individuals, and more common in men than in women. The peak prevalence rate of abnormal ECGs occurred among seropositive individuals between 25 and 44 years of age; in this age group ECG abnormalities occurred 9.6 times more frequently among seropositive individuals than among seronegative individuals. The most common abnormalities were ventricular conduction defects, and right bundle branch block with or without fascicular block occurred in 10.7% of the infected population. PR intervals were longer in seropositive individuals than in seronegative individuals. Ventricular extrasystoles were slightly more common in seropositive individuals. A declining prevalence rate of abnormal ECGs among older seropositive individuals suggested selective mortality due to Chagas' heart disease.

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Cited by (50)

Electrocardiographic and Echocardiographic Abnormalities in Chagas Disease Findings in Residents of Rural Bolivian Communities Hyperendemic for Chagas Disease
2015, Global Heart
Citation Excerpt :
In our population, RBBB, alone or in combination with left anterior fascicular block, were the most frequent abnormalities consistent with Chagas cardiomyopathy. These findings are consistent with results of other community-based studies conducted in other parts of Bolivia and in Brazil [21–23]. In our data, the prevalence of ECG abnormalities rose steadily with age.
Chagas disease is a neglected and preventable tropical disease that causes significant cardiac morbidity and mortality in Latin America.
This study sought to describe cardiac findings among inhabitants of rural communities of the Bolivian Chaco.
The cardiac study drew participants from an epidemiologic study in 7 indigenous Guarani communities. All infected participants 10 years or older were asked to undergo a brief physical examination and 12-lead electrocardiogram (ECG). A subset had echocardiograms. ECG and echocardiograms were read by 1 or more cardiologists.
Of 1,137 residents 10 years or older, 753 (66.2%) had Trypanosoma cruzi infection. Cardiac evaluations were performed for 398 infected participants 10 years or older. Fifty-five participants (13.8%) had 1 or more ECG abnormalities suggestive of Chagas cardiomyopathy. The most frequent abnormalities were bundle branch blocks in 42 (11.3%), followed by rhythm disturbances or ventricular ectopy in 13 (3.3%), and atrioventricular blocks (AVB) in 10 participants (2.6%). The prevalence of any abnormality rose from 1.1% among those 10 to 19 years old to 14.2%, 17.3%, and 26.4% among those 20 to 39, 40 to 59, and older than 60 years, respectively. First-degree AVB was seen most frequently in participants 60 years or older, but the 4 patients with third-degree AVB were all under 50 years old. Eighteen and 2 participants had a left ventricular ejection fraction of 40% to 54% and <40%, respectively. An increasing number of ECG abnormalities was associated with progressively larger left ventricular end-diastolic dimensions and lower left ventricular ejection fraction.
We found a high prevalence of ECG abnormalities and substantial evidence of Chagas cardiomyopathy. Programs to improve access to basic cardiac care (annual ECG, antiarrhythmics, pacemakers) could have an immediate impact on morbidity and mortality in these highly endemic communities.
Prevalence of Chagas Heart Disease in a Region Endemic for Trypanosoma Cruzi Evidence from a Central Bolivian Community
2015, Global Heart
Citation Excerpt :
Second, we excluded adults over age 60 years to minimize nonspecific cardiac disease such as paroxysmal atrial fibrillation. Although the work of Lima-Costa et al. [33,34] indicates that Chagas may be a greater problem in elderly patients than was previously recognized, previous studies have found the majority of cardiac disease developing in adults between 30 and 50 years old [9–12]. It is possible, however, that our exclusion of adults over age 60 reduced the amount of Chagas heart disease detected.
Though the incidence of new Trypanosoma cruzi infections has decreased significantly in endemic regions in the Americas, medical professionals continue to encounter a high burden of resulting Chagas disease among infected adults. The current prevalence of Chagas heart disease in a community setting is not known; nor is it known how recent insecticide vector control measures may have impacted the progression of cardiac disease in an infected population.
We sought to determine the current prevalence of T. cruzi infection and associated Chagas heart disease in a Bolivian community endemic for T. cruzi.
Nested within a community serosurvey in rural and periurban communities in central Bolivia, we performed a cross-sectional cardiac substudy to evaluate adults for historical, clinical, and electrocardiographic evidence of cardiac disease. All adults between the ages of 20 and 60 years old with T. cruzi infection and those with a clinical history, physical exam, or electrocardiogram consistent with cardiac abnormalities were also scheduled for echocardiography.
Of the 604 cardiac substudy participants with definitive serology results, 183 were seropositive for infection with T. cruzi (30.3%). Participants who were seropositive for T. cruzi infection were more likely to have conduction system defects (1.6% vs. 0% for complete right bundle branch block and 10.4% vs. 1.9% for any bundle branch block; p = 0.008 and p < 0.001, respectively). However, there was no statistically significant difference in the prevalence of bradycardia among seropositive versus seronegative participants. Echocardiogram findings were not consistent with a high burden of Chagas cardiomyopathy: valvulopathies were the most common abnormality, and few participants were found to have low ejection fraction or left ventricular dilatation. No participants had significant heart failure.
Though almost one-third of adults in the community were seropositive for T. cruzi infection, few had evidence of Chagas heart disease.
The prognostic significance of electrocardiographic changes in Chagas disease
2012, Journal of Electrocardiology
Citation Excerpt :
The ECG was analyzed using the criteria cited above18 under the supervision of one of the authors. In accordance with previous studies2,5,10,15,20-25 and with the criteria for electrocardiographic diagnosis of ChD,18 a new electrocardiographic abnormality was understood to be the occurrence of one of the following abnormalities in the follow-up, as long as it was absent in the initial examination: intraventricular conduction disturbance, atrioventricular conduction disturbance, presence of a pacemaker, atrial fibrillation, atrial flutter or ectopic atrial rhythm, frequent ventricular extrasystoles (≥2 per tracing), pathologic Q waves, low peripheral voltage, left and right ventricular hypertrophy, significant changes in ventricular repolarization (negative T wave >1 mV or ST-segment deviations >1 mm). In addition, changes in heart rate were investigated, as were duration of the QRS complex and the QT interval, measured and corrected by the Bazzet formula.
The meaning of electrocardiographic changes appearing during the clinical follow-up of Chagas disease (ChD) is unknown. In this study, a patient cohort with ChD was followed to describe the electrocardiographic changes that may make it possible to identify patients whose left ventricular function has deteriorated.
The study sample consisted of a prospective cohort followed since 1998 to 1999, involving 220 patients aged 15 to 55 years, 30 controls, and 190 with ChD, without other comorbidities. The group was reexamined between 2004 and 2006, and new electrocardiograms were obtained for 153 patients, 25 (83%) of 30 in the control group and 128 (72%) of 177 in the ChD group. Electrocardiographic variables associated with a significant decrease in ejection fraction (5% or more) were identified.
A significant decrease in ejection fraction was observed in 21 patients in the ChD group (18.7%) but in none of the non-ChD group (P = .024). Only the presence of a new electrocardiographic abnormality and an increase in QRS duration correlated with a decrease in an ejection fraction of 5% or more. QRS duration was correlated with both an increase in left ventricle diastolic diameter and a deterioration in the ejection fraction (r_s = 0.225, P = .017, and r_s = −0.300, P < .001). A QRS increase of 5 milliseconds had 77.8% sensitivity and 62.2% specificity for identifying patients with significant decrease in ejection fraction.
The increase in the duration of the QRS complex and the appearance of new electrocardiographic alterations may help in identifying patients with a significant decrease (of 5% or more) in left ventricle ejection fraction.
The impact of concomitant infections by Trypanosoma cruzi and intestinal helminths on the health of wild golden and golden-headed lion tamarins
2010, Research in Veterinary Science
A 4-year longitudinal epidemiological study was carried out to evaluate the effect of infection by Trypanosoma cruzi and three intestinal helminth species on the health of golden and golden-headed lion tamarins. We evaluated health using analysis of blood counts, serum proteins, electrophoretograms, electrocardiograms and a health ranking based on physiological parameters. Among the helminths, Trichostrongylidae was demonstrated as the most pathogenic, followed by Prosthenorchis sp.; concomitant infection by Spiruridae may exacerbate the negative effects of the other two helminths. T. cruzi infection was not highly detrimental to the health of the study animals and was correlated with increased resilience to helminths. Tamarins younger than 1-year of age or older than 4-years had lower health condition. Golden-headed lion tamarins were in lower health condition because of higher parasitic prevalence. Our data suggest that when parasite community pathogenicity and prevalence are high, natural selection will allow survival only of lion tamarins in the best health condition.
Early detection of myocardial dysfunction in Chagas disease using novel echocardiographic indices
2003, Transactions of the Royal Society of Tropical Medicine and Hygiene
The first manifestation of cardiac involvement in Chagas disease could be sudden death or rapid deterioration in cardiac function. The aim of this study was to identify a non-invasive method for early detection of cardiac involvement in patients with Chagas disease. During a 6-month period in 2001, 133 people were studied using echocardiography and electrocardiography in Honduras; 88 were seropositive for Trypanosoma cruzi, of which 31 were asymptomatic, and 45 were seronegative controls. The echocardiographic assessment included geometrical and time interval derived indices. Patients with asymptomatic Chagas disease had increased left and right myocardial performance index (MPI) when compared with seronegative controls (P= 0.003 and P= 0.023, respectively) with 36% having a left above the upper limit of the normal range. They also had a reduced diastolic posterior wall thickness (P= 0.005) and lower posterior wall thickness to left ventricular cavity (PWT:LVC) ratio (P= 0.002). Our results show that the MPI, a simple Doppler parameter, and the PWT:LVC ratio are useful in the early detection of myocardial involvement in asymptomatic patients with Chagas disease. These parameters could serve as useful screening tools and monitor the disease progression in these patients.
Association between typical electrocardiographic abnormalities and NT-proBNP elevation in a large cohort of patients with Chagas disease from endemic area
2018, Journal of Electrocardiology
Citation Excerpt :
There is no typical distribution of electrocardiographic variables between the genders that could have clinical significance. In this cohort, men had more major ECG abnormalities than women, which was observed in a Brazilian healthy population [18] and was described in Chagas disease patients [28]. Nevertheless, sex had no significant impact on the final model.
Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram is a well-studied exam and has been considered an important tool for detection and evaluation of Chagas cardiomyopathy since the first years of its description. Many of its abnormalities have been described as associated with a worse prognosis. Serum BNP levels were described as inversely related to the left ventricular ejection fraction and as an independent predictor of death. It was not reported how electrocardiographic alterations correlate to NT-proBNP and its analog. The present study aims to describe the baseline electrocardiograms of a large cohort of patients with Chagas disease from endemic area and to establish an association between the number of electrocardiogram alterations and high levels of NT-ProBNP in Chagas disease patients. This study selected 1959 Chagas disease patients in 21 municipalities within a limited region in the northern part of the State of Minas Gerais (Brazil), 1084 of them had Chagas cardiomyopathy. NT-proBNP levels were suggestive of heart failure in 11.7% of this population. One or more electrocardiographic alterations have an Odds Ratio of 9.12 (CI 95% 5.62–14.80) to have NT-proBNP elevation. Considering the association between the number of 1, 2, and 3 or more alterations in electrocardiogram and NT-proBNP elevation, the ORs were 7.11 (CI 95% 4.33–11.67); 16.04 (CI 95% 9.27–27.77) and 47.82 (CI 95% 17.98–127.20), respectively. The presence and the number of typical electrocardiographic alterations of Chagas disease are independently associated with the severity of the cardiomyopathy.

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^☆: The Harvard component is supported by a grant from the Wellcome Trust and by National Institutes of Health Grant No. AI-16305, under the direction of Dr. Thomas H. Weller, and its collaborative activities in Brazil are under the aegis of the Pan American Health Organization.

^†: Deceased.

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Relationship of electrocardiographic abnormalities and seropositivity to Trypanosoma cruzi within a rural community in Northeast Brazil☆

Abstract

Am Heart J

Am Heart J

Am Heart J

Health conditions in the Americas 1969–1972

Pan Am Health Org Sci Pub

Observações clinicas e epidemiológicas sôbre a moléstia de Chagas no oeste de Minas Gerais

O Hospital (Rio de Janeiro)

Chagas' disease, a clinical, epidemiologic and pathologic study

Circulation

Epidemiologia de la enfermedad de Chagas' en la Republica Argentina

O Hospital (Rio de Janeiro)

Doença de Chagas

Mem Inst Oswaldo Cruz

Clinical and epidemiological study of chronic heart involvement in Chagas' disease

Bull WHO

A 4-year follow-up study of a rural community with endemic Chagas' disease

Bull WHO

Epidemiological pattern of Chagas' disease in an endemic area of Costa Rica

Am J Trop Med Hyg

Estudios sobre la cardiopatia Chagásica en el medio rural Venezolano

Arch Venez Med Trop Parasit Med

Dados sorológicos e electrocardiográficos obtidos em populações não selecionadas de zonas endêmicas de doença de Chagas no estado do Rio Grande do Sul

Rev Bras Malariol Doencas Trop

O eletrocardiograma no prognóstico e evolução da doença de Chagas

Arq Bras Cardiol

Alterações electrocardiográficas na doença de Chagas no nordeste do Brasil

Rev Bras Malariol Doencas Trop

The epidemiology and household distribution of seroreactivity to Trypanosoma cruzi in a rural community in northeast Brazil

Am J Trop Med Hyg

Die Komplementbindungsreaktion der Chagaskrankheit

Z Tropenmed Parasitol