Abstract
Chagas disease (CD) remains a major cause of cardiomyopathy and stroke in developing countries. Brain involvement in CD has been attributed to left ventricular dysfunction, resulting in chronic brain ischemia due to hypoperfusion and/or embolic infarcts. However, cognitive impairment in CD may occur independently of cardiac disease. Therefore, we aimed to investigate head computed tomography (CT) findings in patients with Chagas disease cardiomyopathy (CDC) in comparison with other cardiomyopathies (OC). We studied 73 patients with CDC (n = 41) or OC (n = 32) matched for age and gender. These patients underwent head CT, rated by an investigator blinded to all clinical information. Head CT was rated for the presence of lacunar or territorial infarcts, as well as for measuring the total volumes of the brain, cerebellum and ventricles. Total brain volume was smaller in CDC as compared to OC patients (1,135 ± 150 vs. 1,332 ± 198 cm3, P < 0.001). Cerebellar and ventricular volumes did not differ between the groups. The prevalence of brain infarcts did not differ significantly between the groups. Chagas disease was the only independent predictor of brain atrophy in the multivariable analysis (OR = 1.38; 95% CI = 1.06–1.79, P = 0.017). Chagas disease is associated with brain atrophy independent of structural cardiac disease related to cardiomyopathy. Brain atrophy, rather than multiple infarcts, may represent the main anatomical substrate of cognitive impairment in Chagas disease.
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References
Abramoff MD, Magelhaes PJ, Ram SJ (2004) Image processing with ImageJ. Biophotonics Int 11:36–42
Carod-Artal FJ, Vargas AP, Melo M, Horan TA (2003) American trypanosomiasis (Chagas’ disease): an unrecognised cause of stroke. J Neurol Neurosurg Psychiatry 74:516–518. doi:10.1136/jnnp.74.4.516
Chagas C (1911) New morbid entity in man: general summary of clinical and etiological studies. Mem Inst Oswaldo Cruz 3:219–275
Chandrasekar B, Melby PC, Troyer DA, Freeman GL (1996) Induction of proinflammatory cytokine expression in experimental acute Chagasic cardiomyopathy. Biochem Biophys Res Commun 223:365–371. doi:10.1006/bbrc.1996.0900
Crema E, Monteiro Ide O, Gomes MG, Silva AA, Rodrigues Junior V (2006) Evaluation of cytokines (MIG, IFN-gamma, TNF-alpha, IL-4, IL-5, and IL-10) during the different evolutive phases of chagasic esophagopathy. Clin Immunol 119:213–218. doi:10.1016/j.clim.2005.12.011
de Queiroz AC, Ramos EA (1979) Anatomo-pathological study of the brain in idiopathic cardiomegaly. Arq Neuropsiquiatr 37:405–411
Jefferson AL, Massaro JM, Wolf PA, Seshadri S, Au R, Vasan RS, Larson MG, Meigs JB, Keaney JF Jr, Lipinska I, Kathiresan S, Benjamin EJ, DeCarli C (2007) Inflammatory biomarkers are associated with total brain volume: the Framingham Heart Study. Neurology 68:1032–1038. doi:10.1212/01.wnl.0000257815.20548.df
Oliveira-Filho J (2009) Stroke and brain atrophy in chronic Chagas disease patients: a new theory proposition. Dementia Neuropsychol 3:22–26
Pitella JE (1984) Ischemic cerebral changes in the chronic chagasic cardiopathy. Arq Neuropsiquiatr 42:105–115
Pittella JE (1993) Central nervous system involvement in Chagas’ disease. An updating. Rev Inst Med Trop Sao Paulo 35:111–116. doi:10.1590/S0036-46651993000200001
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Oliveira-Filho, J., Vieira-de-Melo, R.M., Reis, P.S.O. et al. Chagas disease is independently associated with brain atrophy. J Neurol 256, 1363–1365 (2009). https://doi.org/10.1007/s00415-009-5105-7
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DOI: https://doi.org/10.1007/s00415-009-5105-7