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Current Cardiology Reports

, 21:8 | Cite as

Chagas Cardiomyopathy in Latin America Review

  • Jefferson Luis VieiraEmail author
  • Fábio Rocha Fernandes Távora
  • Maria Gyslane Vasconcelos Sobral
  • Glauber Gean Vasconcelos
  • Germana Porto Linhares Almeida
  • Juliana Rolim Fernandes
  • Laura Leite da Escóssia Marinho
  • Daniel Francisco de Mendonça Trompieri
  • João David De Souza Neto
  • Juan Alberto Cosquillo Mejia
Heart Failure (HJ Eisen, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Heart Failure

Abstract

Purpose of Review

Chagas cardiomyopathy is a major public health disease in Latin America and, due to migration, is becoming a worldwide health and economic burden. This review sought to present the clinical and epidemiological aspects of Chagas cardiomyopathy, as well as some specific features and principles of treatment. We also retrospectively assessed our institutional experience with mechanical circulatory support in refractory heart failure due to Chagas cardiomyopathy over a 10-year period.

Recent Findings

The role of antiparasitic treatment in patients with heart failure due to Chagas cardiomyopathy is controversial. Heart transplantation, although formerly contraindicated, is currently established as an important therapeutic option. Also, the favorable characteristics of Chagas patients, such as younger age, little comorbidity, and no reoperations or severe pulmonary hypertension, could be an advantage for a mechanical circulatory support indication in advanced heart failure due to Chagas cardiomyopathy.

Summary

Despite the absence of large evidence-based data, much has been accomplished since Carlos Chagas’ discovery one century ago. Our institutional experience shows that mechanical circulatory support in Chagas patients is associated with more successful bridging to heart transplantation when compared to non-Chagas patients.

Keywords

Chagas disease Cardiomyopathy Heart failure Anatomopathology Heart transplantation Mechanical circulatory support 

Notes

Compliance with Ethical Standards

Conflict of Interest

Jefferson Luis Vieira, Fábio Rocha Fernandes Távora, Maria Gyslane Vasconcelos Sobral, Glauber Gean Vasconcelos, Germana Porto Linhares Almeida, Juliana Rolim Fernandes, Laura Leite da Escóssia Marinho, Daniel Francisco de Mendonça Trompieri, João David De Souza Neto, and Juan Alberto Cosquillo Mejia declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bestetti RB, Restini CB, Couto LB. Carlos Chagas discoveries as a drop back to scientific construction of chronic Chagas heart disease. Arq Bras Cardiol. 2016;107(1):63–70.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Andrade JP, Marin-Neto JA, Paola AA, Vilas-Boas F, Oliveira GM, Bacal F, et al. I Latin American guidelines for the diagnosis and treatment of Chagas cardiomyopathy. Arq Bras Cardiol. 2011;97(2 Suppl 3):1–48.PubMedGoogle Scholar
  3. 3.
    Hotez PJ, Dumonteil E, Woc-Colburn L, Serpa JA, Bezek S, Edwards MS, et al. Chagas disease: “the new HIV/AIDS of the Americas”. PLoS Negl Trop Dis. 2012;6(5):e1498.CrossRefGoogle Scholar
  4. 4.
    Kalil-Filho R. Globalization of Chagas disease burden and new treatment perspectives. J Am Coll Cardiol. 2015;66(10):1190–2.CrossRefGoogle Scholar
  5. 5.
    Lee BY, Bacon KM, Bottazzi ME, Hotez PJ. Global economic burden of Chagas disease: a computational simulation model. Lancet Infect Dis. 2013;13(4):342–8.CrossRefGoogle Scholar
  6. 6.
    Bern C, Montgomery SP, Herwaldt BL, Rassi A, Marin-Neto JA, Dantas RO, et al. Evaluation and treatment of chagas disease in the United States: a systematic review. JAMA. 2007;298(18):2171–81.CrossRefGoogle Scholar
  7. 7.
    Benziger CP, do Carmo GA, Ribeiro AL. Chagas cardiomyopathy: clinical presentation and management in the Americas. Cardiol Clin. 2017;35(1):31–47.CrossRefGoogle Scholar
  8. 8.
    Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388–402.CrossRefGoogle Scholar
  9. 9.
    Robertson LJ, Devleesschauwer B, Alarcón de Noya B, Noya González O, Torgerson PR. Trypanosoma cruzi: time for international recognition as a foodborne parasite. PLoS Negl Trop Dis. 2016;10(6):e0004656.CrossRefGoogle Scholar
  10. 10.
    Cevallos AM, Hernández R. Chagas’ disease: pregnancy and congenital transmission. Biomed Res Int. 2014;2014:401864.CrossRefGoogle Scholar
  11. 11.
    World Health Organization. (2018). Chagas disease (American trypanosomiasis), 2018. Retrieved from http://www.who.int/chagas/epidemiology/en/. Accessed 8 Aug 2018.
  12. 12.
    • Benatti RD, Al-Kindi SG, Bacal F, Oliveira GH. Heart transplant outcomes in patients with Chagas cardiomyopathy in the United States. Clin Transplant. 2018;32:e13279 This study provides an up-to-date review on heart transplant outcomes in patients with Chagas cardiomyopathy.CrossRefGoogle Scholar
  13. 13.
    •• Bocchi EA, Bestetti RB, Scanavacca MI, Cunha Neto E, Issa VS. Chronic Chagas heart disease management: from etiology to cardiomyopathy treatment. J Am Coll Cardiol. 2017;70(12):1510–24 This study provides a thorough description of Chagas cardiomyopathy treatment. CrossRefGoogle Scholar
  14. 14.
    LiÚni KCF, Bavia L, Ambrosio AR, de Messias-Reason IJ. The complement system: a prey of Trypanosoma cruzi. Front Microbiol. 2017;8:607.CrossRefGoogle Scholar
  15. 15.
    Lauria-Pires L, Braga MS, Vexenat AC, Nitz N, Simões-Barbosa A, Tinoco DL, et al. Progressive chronic Chagas heart disease ten years after treatment with anti-Trypanosoma cruzi nitroderivatives. Am J Trop Med Hyg. 2000;63(3–4):111–8.CrossRefGoogle Scholar
  16. 16.
    Nunes MC, Dones W, Morillo CA, Encina JJ, Ribeiro AL, Cardiology CoCDotISo. Chagas disease: an overview of clinical and epidemiological aspects. J Am Coll Cardiol. 2013;62(9):767–76.CrossRefGoogle Scholar
  17. 17.
    Souza DH, Vaz MG, Fonseca CR, Luquetti A, Rezende Filho J, Oliveira EC. Current epidemiological profile of Chagasic megaesophagus in Central Brazil. Rev Soc Bras Med Trop. 2013;46(3):316–21.CrossRefGoogle Scholar
  18. 18.
    Cunha-Neto E, Chevillard C. Chagas disease cardiomyopathy: immunopathology and genetics. Mediat Inflamm. 2014;2014:683230.CrossRefGoogle Scholar
  19. 19.
    Mocelin AO, Issa VS, Bacal F, Guimarães GV, Cunha E, Bocchi EA. The influence of aetiology on inflammatory and neurohumoral activation in patients with severe heart failure: a prospective study comparing Chagas’ heart disease and idiopathic dilated cardiomyopathy. Eur J Heart Fail. 2005;7(5):869–73.CrossRefGoogle Scholar
  20. 20.
    Bocchi EA. Update on indications and results of the surgical treatment of heart failure. Arq Bras Cardiol. 1994;63(6):523–30.PubMedGoogle Scholar
  21. 21.
    Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, Rassi GG, et al. Development and validation of a risk score for predicting death in Chagas’ heart disease. N Engl J Med. 2006;355(8):799–808.CrossRefGoogle Scholar
  22. 22.
    Freitas HF, Chizzola PR, Paes AT, Lima AC, Mansur AJ. Risk stratification in a Brazilian hospital-based cohort of 1220 outpatients with heart failure: role of Chagas’ heart disease. Int J Cardiol. 2005;102(2):239–47.CrossRefGoogle Scholar
  23. 23.
    Abuhab A, Trindade E, Aulicino GB, Fujii S, Bocchi EA, Bacal F. Chagas’ cardiomyopathy: the economic burden of an expensive and neglected disease. Int J Cardiol. 2013;168(3):2375–80.CrossRefGoogle Scholar
  24. 24.
    Barbosa AP, Cardinalli Neto A, Otaviano AP, Rocha BF, Bestetti RB. Comparison of outcome between Chagas cardiomyopathy and idiopathic dilated cardiomyopathy. Arq Bras Cardiol. 2011;97(6):517–25.CrossRefGoogle Scholar
  25. 25.
    Martinelli Filho M, De Siqueira SF, Moreira H, Fagundes A, Pedrosa A, Nishioka SD, et al. Probability of occurrence of life-threatening ventricular arrhythmias in Chagas’ disease versus non-Chagas’ disease. Pacing Clin Electrophysiol. 2000;23(11 Pt 2):1944–6.CrossRefGoogle Scholar
  26. 26.
    Bestetti RB, Cardinalli-Neto A. Sudden cardiac death in Chagas’ heart disease in the contemporary era. Int J Cardiol. 2008;131(1):9–17.CrossRefGoogle Scholar
  27. 27.
    Ribeiro AL, Rocha MO. Indeterminate form of Chagas disease: considerations about diagnosis and prognosis. Rev Soc Bras Med Trop. 1998;31(3):301–14.CrossRefGoogle Scholar
  28. 28.
    Seiringer P, Pritsch M, Flores-Chavez M, Marchisio E, Helfrich K, Mengele C, et al. Comparison of four PCR methods for efficient detection of Trypanosoma cruzi in routine diagnostics. Diagn Microbiol Infect Dis. 2017;88(3):225–32.CrossRefGoogle Scholar
  29. 29.
    Traina MI, Hernandez S, Sanchez DR, Dufani J, Salih M, Abuhamidah AM, et al. Prevalence of Chagas disease in a U.S. population of Latin American immigrants with conduction abnormalities on electrocardiogram. PLoS Negl Trop Dis. 2017;11(1):e0005244.CrossRefGoogle Scholar
  30. 30.
    Maguire JH, Hoff R, Sherlock I, Guimarães AC, Sleigh AC, Ramos NB, et al. Cardiac morbidity and mortality due to Chagas’ disease: prospective electrocardiographic study of a Brazilian community. Circulation. 1987;75(6):1140–5.CrossRefGoogle Scholar
  31. 31.
    Ribeiro AL, Sabino EC, Marcolino MS, Salemi VM, Ianni BM, Fernandes F, et al. Electrocardiographic abnormalities in Trypanosoma cruzi seropositive and seronegative former blood donors. PLoS Negl Trop Dis. 2013;7(2):e2078.CrossRefGoogle Scholar
  32. 32.
    Rassi A, Rassi SG. Predictors of mortality in chronic Chagas disease: a systematic review of observational studies. Circulation. 2007;115(9):1101–8.CrossRefGoogle Scholar
  33. 33.
    Pazin-Filho A, Romano MM, Almeida-Filho OC, Furuta MS, Viviani LF, Schmidt A, et al. Minor segmental wall motion abnormalities detected in patients with Chagas’ disease have adverse prognostic implications. Braz J Med Biol Res. 2006;39(4):483–7.CrossRefGoogle Scholar
  34. 34.
    Acquatella H. Echocardiography in Chagas heart disease. Circulation. 2007;115(9):1124–31.CrossRefGoogle Scholar
  35. 35.
    Viotti RJ, Vigliano C, Laucella S, Lococo B, Petti M, Bertocchi G, et al. Value of echocardiography for diagnosis and prognosis of chronic Chagas disease cardiomyopathy without heart failure. Heart. 2004;90(6):655–60.CrossRefGoogle Scholar
  36. 36.
    Barros MV, da Costa Rocha MO, Ribeiro AL, Machado FS. Tissue Doppler imaging enables the identification of diastolic dysfunction of pseudonormal pattern in Chagas’ disease. J Am Soc Echocardiogr. 2001;14(5):353–9.CrossRefGoogle Scholar
  37. 37.
    Garcia-Alvarez A, Sitges M, Pinazo MJ, Regueiro-Cueva A, Posada E, Poyatos S, Ortiz-Pérez JT, Heras M, Azqueta M, Gascon J, Sanz G. Chagas cardiomyopathy: the potential of diastolic dysfunction and brain natriuretic peptide in the early identification of cardiac damage. PLoS Negl Trop Dis 2010;4(9).  https://doi.org/10.1371/journal.pntd.0000826.
  38. 38.
    Keating SM, Deng X, Fernandes F, Cunha-Neto E, Ribeiro AL, Adesina B, et al. Inflammatory and cardiac biomarkers are differentially expressed in clinical stages of Chagas disease. Int J Cardiol. 2015;199:451–9.CrossRefGoogle Scholar
  39. 39.
    Sherbuk JE, Okamoto EE, Marks MA, Fortuny E, Clark EH, Galdos-Cardenas G, et al. Biomarkers and mortality in severe Chagas cardiomyopathy. Glob Heart. 2015;10(3):173–80.CrossRefGoogle Scholar
  40. 40.
    Chatelain E. Chagas disease research and development: is there light at the end of the tunnel? Comput Struct Biotechnol J. 2017;15:98–103.CrossRefGoogle Scholar
  41. 41.
    Bestetti RB, Cardinalli-Neto A. Device therapy in Chagas disease heart failure. Expert Rev Cardiovasc Ther. 2012;10(10):1307–17.CrossRefGoogle Scholar
  42. 42.
    Malik LH, Singh GD, Amsterdam EA. The epidemiology, clinical manifestations, and management of Chagas heart disease. Clin Cardiol. 2015;38(9):565–9.CrossRefGoogle Scholar
  43. 43.
    Araújo EF, Chamlian EG, Peroni AP, Pereira WL, Gandra SM, Rivetti LA. Cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy: long-term follow up. Rev Bras Cir Cardiovasc. 2014;29(1):31–6.CrossRefGoogle Scholar
  44. 44.
    Issa VS, Amaral AF, Cruz FD, Ferreira SM, Guimarães GV, Chizzola PR, et al. Beta-blocker therapy and mortality of patients with Chagas cardiomyopathy: a subanalysis of the REMADHE prospective trial. Circ Heart Fail. 2010;3(1):82–8.CrossRefGoogle Scholar
  45. 45.
    Pérez-Molina JA, Molina I. Chagas disease. Lancet. 2018;391(10115):82–94.CrossRefGoogle Scholar
  46. 46.
    Marin-Neto JA, Rassi A, Avezum A, Mattos AC, Morillo CA, Sosa-Estani S, et al. The BENEFIT trial: testing the hypothesis that trypanocidal therapy is beneficial for patients with chronic Chagas heart disease. Mem Inst Oswaldo Cruz. 2009;104(Suppl 1):319–24.CrossRefGoogle Scholar
  47. 47.
    • Morillo CA, Marin-Neto JA, Avezum A, Sosa-Estani S, Rassi A, Rosas F, et al. Randomized trial of Benznidazole for chronic Chagas’ cardiomyopathy. N Engl J Med. 2015;373(14):1295–306 The BENEFIT is the largest randomized trial on Chagas disease.CrossRefGoogle Scholar
  48. 48.
    Rassi A, Marin JA. Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole evaluation for interrupting trypanosomiasis (BENEFIT) trial. Mem Inst Oswaldo Cruz. 2017;112(3):224–35.CrossRefGoogle Scholar
  49. 49.
    Molina I, Gómez i Prat J, Salvador F, Treviño B, Sulleiro E, Serre N, et al. Randomized trial of posaconazole and benznidazole for chronic Chagas’ disease. N Engl J Med. 2014;370(20):1899–908.CrossRefGoogle Scholar
  50. 50.
    Morillo CA, Waskin H, Sosa-Estani S, Del Carmen Bangher M, Cuneo C, Milesi R, et al. Benznidazole and Posaconazole in eliminating parasites in asymptomatic T. Cruzi carriers: The STOP-CHAGAS Trial. J Am Coll Cardiol. 2017;69(8):939–47.CrossRefGoogle Scholar
  51. 51.
    Torrico F, Gascon J, Ortiz L, Alonso-Vega C, Pinazo MJ, Schijman A, et al. Treatment of adult chronic indeterminate Chagas disease with benznidazole and three E1224 dosing regimens: a proof-of-concept, randomised, placebo-controlled trial. Lancet Infect Dis. 2018;18(4):419–30.CrossRefGoogle Scholar
  52. 52.
    Bocchi E. Chagas disease cardiomyopathy treatment remains a challenge. Lancet. 2018;391(10136):2209.CrossRefGoogle Scholar
  53. 53.
    Pérez-Molina JA, Molina I. Chagas disease cardiomyopathy treatment remains a challenge – Authors’ reply. Lancet. 2018;391(10136):2209–10.CrossRefGoogle Scholar
  54. 54.
    • Kransdorf EP, Fishbein MC, Czer LS, Patel JK, Velleca A, Tazelaar HD, et al. Pathology of chronic Chagas cardiomyopathy in the United States: a detailed review of 13 cardiectomy cases. Am J Clin Pathol. 2016;146(2):191–8 This study provides information on Chagas cardiomyopathy anatomopathology.CrossRefGoogle Scholar
  55. 55.
    Souza JD, Torres A, Mejia JA, Fernandes JR, Vasconcelos GG, Pessoa V, et al. Allograft pathology in patients transplanted in a reference center, including cases of Chagas cardiomyopathy. Eur J Heart Fail Suppl. 2013;12:S73–S325.  https://doi.org/10.1093/eurjhf/hst009. CrossRefGoogle Scholar
  56. 56.
    Kransdorf EP, Czer LS, Luthringer DJ, Patel JK, Montgomery SP, Velleca A, et al. Heart transplantation for Chagas cardiomyopathy in the United States. Am J Transplant. 2013;13(12):3262–8.CrossRefGoogle Scholar
  57. 57.
    Benatti RD, Oliveira GH, Bacal F. Heart transplantation for Chagas cardiomyopathy. J Heart Lung Transplant. 2017;36(6):597–603.CrossRefGoogle Scholar
  58. 58.
    Fiorelli AI, Santos RH, Oliveira JL, Lourenço-Filho DD, Dias RR, Oliveira AS, et al. Heart transplantation in 107 cases of Chagas’ disease. Transplant Proc. 2011;43(1):220–4.CrossRefGoogle Scholar
  59. 59.
    Bestetti RB, Theodoropoulos TA. A systematic review of studies on heart transplantation for patients with end-stage Chagas’ heart disease. J Card Fail. 2009;15(3):249–55.CrossRefGoogle Scholar
  60. 60.
    Bocchi EA, Fiorelli A. The paradox of survival results after heart transplantation for cardiomyopathy caused by Trypanosoma cruzi. First Guidelines Group for Heart Transplantation of the Brazilian Society of Cardiology. Ann Thorac Surg. 2001;71(6):1833–8.CrossRefGoogle Scholar
  61. 61.
    Mangini S, Alves BR, Silvestre OM, Pires PV, Pires LJ, Curiati MN, et al. Heart transplantation: review. Einstein (Sao Paulo). 2015;13(2):310–8.CrossRefGoogle Scholar
  62. 62.
    Bocchi EA. Heart transplants for patients with Chagas’ heart disease. Sao Paulo Med J. 1995;113(2):873–9.CrossRefGoogle Scholar
  63. 63.
    Bocchi EA, Fiorelli A, Cardiology FGGfHTotBSo. The Brazilian experience with heart transplantation: a multicenter report. J Heart Lung Transplant. 2001;20(6):637–45.CrossRefGoogle Scholar
  64. 64.
    Nogueira SS, Felizardo AA, Caldas IS, Gonçalves RV, Novaes RD. Challenges of immunosuppressive and antitrypanosomal drug therapy after heart transplantation in patients with chronic Chagas disease: a systematic review of clinical recommendations. Transplant Rev (Orlando). 2018;32:157–67.CrossRefGoogle Scholar
  65. 65.
    Campos SV, Strabelli TM, Amato Neto V, Silva CP, Bacal F, Bocchi EA, et al. Risk factors for Chagas’ disease reactivation after heart transplantation. J Heart Lung Transplant. 2008;27(6):597–602.CrossRefGoogle Scholar
  66. 66.
    Bacal F, Silva CP, Bocchi EA, Pires PV, Moreira LF, Issa VS, et al. Mychophenolate mofetil increased chagas disease reactivation in heart transplanted patients: comparison between two different protocols. Am J Transplant. 2005;5(8):2017–21.CrossRefGoogle Scholar
  67. 67.
    Fiorelli AI, Stolf NA, Honorato R, Bocchi E, Bacal F, Uip D, et al. Later evolution after cardiac transplantation in Chagas’ disease. Transplant Proc. 2005;37(6):2793–8.CrossRefGoogle Scholar
  68. 68.
    Kransdorf EP, Zakowski PC, Kobashigawa JA. Chagas disease in solid organ and heart transplantation. Curr Opin Infect Dis. 2014;27(5):418–24.CrossRefGoogle Scholar
  69. 69.
    Chin-Hong PV, Schwartz BS, Bern C, Montgomery SP, Kontak S, Kubak B, et al. Screening and treatment of chagas disease in organ transplant recipients in the United States: recommendations from the chagas in transplant working group. Am J Transplant. 2011;11(4):672–80.CrossRefGoogle Scholar
  70. 70.
    Schwartz BS, Mawhorter SD, Practice AIDCo. Parasitic infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):280–303.CrossRefGoogle Scholar
  71. 71.
    Bern C. Antitrypanosomal therapy for chronic Chagas’ disease. N Engl J Med. 2011;364(26):2527–34.CrossRefGoogle Scholar
  72. 72.
    Moreira LP, Galantier J, Benicio A, Leirner AA, Fiorelli AI, Stolf NAG, et al. Clinical perspectives of patients with Chagas cardiomyopathy listed as high priority for heart transplantation. Braz J Cardiovasc Surg. 2005;20(3):261–9.CrossRefGoogle Scholar
  73. 73.
    Leirner AA, Moreira LF, Stolf NA. The role of circulatory assistance and heart transplantation in Chagas’ disease cardiomyopathy. Artif Organs. 2007;31(4):245–8.CrossRefGoogle Scholar
  74. 74.
    Moreira LF, Galantier J, Benício A, Leirner AA, Cestari IA, Stolf NA. Left ventricular circulatory support as bridge to heart transplantation in Chagas’ disease cardiomyopathy. Artif Organs. 2007;31(4):253–8.CrossRefGoogle Scholar
  75. 75.
    Ruzza A, Czer LS, De Robertis M, Luthringer D, Moriguchi J, Kobashigawa J, et al. Total artificial heart as bridge to heart transplantation in Chagas cardiomyopathy: case report. Transplant Proc. 2016;48(1):279–81.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jefferson Luis Vieira
    • 1
    Email author
  • Fábio Rocha Fernandes Távora
    • 1
  • Maria Gyslane Vasconcelos Sobral
    • 1
  • Glauber Gean Vasconcelos
    • 1
  • Germana Porto Linhares Almeida
    • 1
  • Juliana Rolim Fernandes
    • 1
  • Laura Leite da Escóssia Marinho
    • 1
  • Daniel Francisco de Mendonça Trompieri
    • 1
  • João David De Souza Neto
    • 1
  • Juan Alberto Cosquillo Mejia
    • 1
  1. 1.Messejana Heart and Lung Hospital Dr. Carlos Alberto Studart GomesFortalezaBrazil

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