| Journal: | Revista do Instituto de Medicina Tropical de Sao Paulo |
| Database: | |
| System number: | 000537105 |
| ISSN: | 0036-4665 |
| Authors: | Buss, Lewis F.1 Bes, Taniela Marli1 Pereira, Alexandre2 Natany, Larissa3 Oliveira, Claudia Di Lorenzo4 Ribeiro, Antonio Luiz P5 Sabino, Ester Cerdeira1 |
| Institutions: | 1Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo. Brasil 2Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo. Brasil 3Universidade Federal de Minas Gerais, Departamento de Estatística, Belo Horizonte, Minas Gerais. Brasil 4Universidade Federal de São João del-Rei, São João del-Rey, Minas Gerais. Brasil 5Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, Minas Gerais. Brasil |
| Year: | 2021 |
| Volumen: | 63 |
| Country: | Brasil |
| Language: | Inglés |
| English abstract | Chagas cardiomyopathy (ChCM) is a severe consequence of Trypanosoma cruzi infection and has a range of electrocardiographic (ECG) and echocardiographic (ECHO) manifestations. There is a need for a standard and parsimonious research cardiac end point that does not rely on expert panel adjudication, and it is not intended to change the ChCM definition. We use data from the REDS-II cohort to propose a simplified cardiac endpoint. A total of 499 T. cruzi-seropositive blood donors were included. All participants underwent a 12-lead ECG, echocardiogram and clinical examination, and those with abnormal findings were reviewed by a panel of cardiologists who classified cases as having Chagas cardiomyopathy or not. We created an exhaustive set of ECG and ECHO finding combinations and compared these with the panel’s classification. We selected the simplest combination that most accurately reproduced the panel’s results. Individual ECG and ECHO variables had low sensitivity for panel-defined cardiomyopathy. The best performing combination was right bundle branch block and/or ECHO evidence of left ventricular hypocontractility. This combination had 98% specificity and 85% sensitivity for panel-defined ChCM. It was not possible to improve the overall accuracy by addition of any other ECG or ECHO variable. Substituting right bundle branch block for the more inclusive finding of QRS interval > 120 ms produced similar results. The combination of prolonged QRS interval and/or left ventricular hypocontractility closely reproduced the REDS-II expert panel classification of Chagas ChCM. In conclusion, the simple and reproducible research endpoint proposed here captures most of the spectrum of cardiac abnormalities in Chagas disease. |
| Keyword: | Chagas disease, Trypanosoma cruzi, Cardiomyopathy, Chagas cardiomyopathy |
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