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Management of Chronic Chagasic Cardiomyopathy in Endemic and Non-endemic Countries: Challenges and Limitations

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Chagas Disease

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Abstract

Management of chronic Chagasic cardiomyopathy (CCC) is a challenge to be faced by cardiologists, neurologists, infectologists, and primary care physicians. In this chapter, we will present how to approach the different clinical aspects of CCC using diagnostic tools and clinical and non-clinical treatment. The physiopathology will not be discussed, as it was already discussed in other chapters of this book.

CCC has a pleiotropic presentation. We will present general guidelines to follow when evaluating patients in outpatient services and the remaining of the chapter will be divided according to CCC three main mechanisms of death: sudden death (arrhythmia), heart failure (HF), and stroke. Other excellent reviews and guidelines are recommended for further details (Nunes et al., Eur Heart J Cardiovasc Imaging 19:459–460, 2018; Nunes et al., Circulation 138:e169–209, 2018; Dias et al., Rev Soc Bras Med Trop 49(Suppl 1):3–60, 2016; Andrade et al., Arq Bras Cardiol 97:1–48, 2011; Rassi et al., Lancet 375:1388–1402, 2010). Among patients with CCC, around 90% of the deaths can be attributed to the complications of Chagas disease. Sudden death is the most common cause of death (55–60%), followed by HF (25–30%) and stroke (10–15%) (Rassi et al., Lancet 375:1388–1402, 2010; Rassi et al., Arq Bras Cardiol 76:75–96, 2001; Salles et al., Circulation 108:305–312, 2003).

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References

  1. Nunes MCP, Beaton A, Acquatella H, Bern C, Bolger AF, Echeverria LE, et al. Chagas cardiomyopathy: an update of current clinical knowledge and management: a scientific statement from the American Heart Association. Circulation. 2018;138:e169–209.

    PubMed  Google Scholar 

  2. Dias JC, Ramos AN Jr, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, et al. 2 nd Brazilian consensus on Chagas disease, 2015. Rev Soc Bras Med Trop. 2016;49(Suppl 1):3–60.

    Google Scholar 

  3. 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;97:1–48.

    PubMed  Google Scholar 

  4. Acquatella H. Echocardiography in Chagas heart disease. Circulation. 2007;115:1124–31.

    PubMed  Google Scholar 

  5. 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;90:655–60.

    PubMed  PubMed Central  CAS  Google Scholar 

  6. Nunes MC, Barbosa MM, Brum VA, Rocha MO. Morphofunctional characteristics of the right ventricle in Chagas’ dilated cardiomyopathy. Int J Cardiol. 2004;94:79–85.

    Google Scholar 

  7. Marin-Neto JA, Bromberg-Marin G, Pazin-Filho A, Simoes MV, Maciel BC. Cardiac autonomic impairment and early myocardial damage involving the right ventricle are independent phenomena in Chagas’ disease. Int J Cardiol. 1998;65:261–9.

    PubMed  CAS  Google Scholar 

  8. Nascimento CA, Gomes VA, Silva SK, Santos CR, Chambela MC, Madeira FS, et al. Left atrial and left ventricular diastolic function in chronic chagas disease. J Am Soc Echocardiogr. 2013;26:1424–33.

    PubMed  Google Scholar 

  9. Koelling TM, Aaronson KD, Cody RJ, Bach DS, Armstrong WF. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J. 2002;144:524–9.

    PubMed  Google Scholar 

  10. Pinto AY, Valente SA, Valente VC, Ferreira Junior AG, Coura JR. Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Para, Amapa and Maranhao observed between 1988 and 2005. Rev Soc Bras Med Trop. 2008;41:602–14.

    PubMed  Google Scholar 

  11. Rassi JA, Rassi A, Marin-Neto JA. Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification. Mem Inst Oswaldo Cruz. 2009;104(Suppl 1):152–8.

    PubMed  Google Scholar 

  12. Rassi JA, Gabriel RA, Gabriel RS, Rassi JL, Rassi A. Ventricular arrhythmia in Chagas disease. Diagnostic, prognostic, and therapeutic features. Arq Bras Cardiol. 1995;65:377–87.

    PubMed  Google Scholar 

  13. Rassi A Jr, Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, et al. Development and validation of a risk score for predicting death in Chagas’ heart disease. N Engl J Med. 2006;355:799–808.

    PubMed  CAS  Google Scholar 

  14. Rincon LG, Rocha MO, Pires MT, Oliveira BG, Barros VC, Barros MV, et al. Clinical profile of Chagas and non-Chagas’ disease patients with cardiac pacemaker. Rev Soc Bras Med Trop. 2006;39:245–9.

    PubMed  Google Scholar 

  15. Ribeiro AL, Marcolino MS, Prineas RJ, Lima-Costa MF. Electrocardiographic abnormalities in elderly chagas disease patients: 10-year follow-up of the Bambui cohort study of aging. J Am Heart Assoc. 2014;3:e000632.

    PubMed  PubMed Central  Google Scholar 

  16. Marcolino MS, Palhares DM, Ferreira LR, Ribeiro AL. Electrocardiogram and Chagas disease: a large population database of primary care patients. Glob Heart. 2015;10:167–72.

    PubMed  Google Scholar 

  17. Cedraz SS, Silva PC, Minowa RK, Aragao JF, Silva DV, Morillo C, et al. Electrophysiological characteristics of Chagas disease. Einstein (Sao Paulo). 2013;11:291–5.

    Google Scholar 

  18. Gallo L Jr, Neto JA, Manco JC, Rassi A, Amorim DS. Abnormal heart rate responses during exercise in patients with Chagas’ disease. Cardiology. 1975;60:147–62.

    PubMed  Google Scholar 

  19. Pereira MH, Brito FS, Ambrose JA, Pereira CB, Levi GC, Neto VA, et al. Exercise testing in the latent phase of Chagas’ disease. Clin Cardiol. 1984;7:261–5.

    PubMed  CAS  Google Scholar 

  20. Pedrosa RC, Campos MC. Exercise testing and 24 hours Holter monitoring in the detection of complex ventricular arrhythmias in different stages of chronic Chagas’ heart disease. Rev Soc Bras Med Trop. 2004;37:376–83.

    PubMed  Google Scholar 

  21. De Paola AA, Gomes JA, Terzian AB, Miyamoto MH, Martinez Fo EE. Ventricular tachycardia during exercise testing as a predictor of sudden death in patients with chronic chagasic cardiomyopathy and ventricular arrhythmias. Br Heart J. 1995;74:293–5.

    PubMed  PubMed Central  Google Scholar 

  22. de Souza SF, Nascimento BR, Nunes MC, da Silva JL, de Carvalho VT, Beaton AZ, et al. Effect of pacemaker site on B-type natriuretic peptide levels and left ventricular function in a population with high prevalence of Chagas disease. Int J Cardiol. 2015;190:315–8.

    PubMed  Google Scholar 

  23. da Silva JO, Borges MC, de Melo CS, Nascente GA, Correia D. Alternative sites for right ventricular pacing in Chagas disease: a comparative study of the mid-septum and inflow tract. Pacing Clin Electrophysiol. 2014;37:1166–73.

    Google Scholar 

  24. Rassi A Jr, Rassi SG, Rassi A. Sudden death in Chagas’ disease. Arq Bras Cardiol. 2001;76:75–96.

    PubMed  Google Scholar 

  25. Ribeiro AL, Nunes MP, Teixeira MM, Rocha MO. Diagnosis and management of Chagas disease and cardiomyopathy. Nat Rev Cardiol. 2012;9:576–89.

    PubMed  CAS  Google Scholar 

  26. Bestetti RB, Cardinalli-Neto A. Sudden cardiac death in Chagas’ heart disease in the contemporary era. Int J Cardiol. 2008;131:9–17.

    PubMed  Google Scholar 

  27. Miranda CH, Figueiredo AB, Maciel BC, Marin-Neto JA, Simoes MV. Sustained ventricular tachycardia is associated with regional myocardial sympathetic denervation assessed with 123I-metaiodobenzylguanidine in chronic Chagas cardiomyopathy. J Nucl Med. 2011;52:504–10.

    PubMed  CAS  Google Scholar 

  28. Stein C, Migliavaca CB, Colpani V, Rosa PRD, Sganzerla D, Giordani NE, et al. Amiodarone for arrhythmia in patients with Chagas disease: a systematic review and individual patient data meta-analysis. PLoS Negl Trop Dis. 2018;12:e0006742.

    PubMed  PubMed Central  Google Scholar 

  29. Piccini JP, Berger JS, O’Connor CM. Amiodarone for the prevention of sudden cardiac death: a meta-analysis of randomized controlled trials. Eur Heart J. 2009;30:1245–53.

    PubMed  CAS  Google Scholar 

  30. Mello RP, Szarf G, Schvartzman PR, Nakano EM, Espinosa MM, Szejnfeld D, et al. Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chronic Chagas’ heart disease. Arq Bras Cardiol. 2012;98:421–30.

    PubMed  Google Scholar 

  31. Ribeiro AL, Cavalvanti PS, Lombardi F, Nunes MC, Barros MV, Rocha MO. Prognostic value of signal-averaged electrocardiogram in Chagas disease. J Cardiovasc Electrophysiol. 2008;19:502–9.

    PubMed  Google Scholar 

  32. Ribeiro AL, Rocha MO, Terranova P, Cesarano M, Nunes MD, Lombardi F. T-wave amplitude variability and the risk of death in Chagas disease. J Cardiovasc Electrophysiol. 2011;22:799–805.

    PubMed  Google Scholar 

  33. Barbosa MPT, da Costa Rocha MO, Neto ES, Brandao FV, Lombardi F, Ribeiro ALP. Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators. Int J Cardiol. 2016;222:80–5.

    PubMed  Google Scholar 

  34. Brugada P. Chagas’ disease and tachycardiomyopathy. Arq Bras Cardiol. 1991;56:5–7.

    PubMed  CAS  Google Scholar 

  35. Benaim G, Sanders JM, Garcia-Marchan Y, Colina C, Lira R, Caldera AR, et al. Amiodarone has intrinsic anti-Trypanosoma cruzi activity and acts synergistically with posaconazole. J Med Chem. 2006;49:892–9.

    PubMed  CAS  Google Scholar 

  36. Barbosa MP, Carmo AA, Rocha MO, Ribeiro AL. Ventricular arrhythmias in Chagas disease. Rev Soc Bras Med Trop. 2015;48:4–10.

    PubMed  Google Scholar 

  37. Barbosa MP, da Costa Rocha MO, de Oliveira AB, Lombardi F, Ribeiro AL. Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease. Europace. 2013;15:957–62.

    PubMed  Google Scholar 

  38. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891–975.

    PubMed  Google Scholar 

  39. Martinelli M, Rassi A Jr, Marin-Neto JA, De Paola AA, Berwanger O, Scanavacca MI, et al. CHronic use of Amiodarone aGAinSt Implantable cardioverter-defibrillator therapy for primary prevention of death in patients with Chagas cardiomyopathy study: rationale and design of a randomized clinical trial. Am Heart J. 2013;166:976–82.

    PubMed  CAS  Google Scholar 

  40. Gali WL, Sarabanda AV, Baggio JM, Ferreira LG, Gomes GG, Marin-Neto JA, et al. Implantable cardioverter-defibrillators for treatment of sustained ventricular arrhythmias in patients with Chagas’ heart disease: comparison with a control group treated with amiodarone alone. Europace. 2014;16:674–80.

    PubMed  Google Scholar 

  41. Cardinalli-Neto A, Bestetti RB, Cordeiro JA, Rodrigues VC. Predictors of all-cause mortality for patients with chronic Chagas’s heart disease receiving implantable cardioverter defibrillator therapy. J Cardiovasc Electrophysiol. 2007;18:1236–40.

    PubMed  Google Scholar 

  42. Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359:1009–17.

    PubMed  PubMed Central  CAS  Google Scholar 

  43. Strauss DG, Cardoso S, Lima JA, Rochitte CE, Wu KC. ECG scar quantification correlates with cardiac magnetic resonance scar size and prognostic factors in Chagas’ disease. Heart. 2011;97:357–61.

    PubMed  Google Scholar 

  44. Tassi EM, Continentino MA, Nascimento EM, Pereira BB, Pedrosa RC. Relationship between fibrosis and ventricular arrhythmias in Chagas heart disease without ventricular dysfunction. Arq Bras Cardiol. 2014;102:456–64.

    PubMed  PubMed Central  Google Scholar 

  45. de Souza AC, Salles G, Hasslocher-Moreno AM, de Sousa AS, Alvarenga Americano do Brasil PE, Saraiva RM, et al. Development of a risk score to predict sudden death in patients with Chaga’s heart disease. Int J Cardiol. 2015;187:700–4.

    PubMed  Google Scholar 

  46. Nunes MCP, Badano LP, Marin-Neto JA, Edvardsen T, Fernandez-Golfin C, Bucciarelli-Ducci C, et al. Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging. 2018;19:459–60.

    PubMed  Google Scholar 

  47. Ribeiro AL, Moraes RS, Ribeiro JP, Ferlin EL, Torres RM, Oliveira E, et al. Parasympathetic dysautonomia precedes left ventricular systolic dysfunction in Chagas disease. Am Heart J. 2001;141:260–5.

    PubMed  CAS  Google Scholar 

  48. Santangeli P, Muser D, Maeda S, Filtz A, Zado ES, Frankel DS, et al. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis of randomized controlled trials. Heart Rhythm. 2016;13:1552–9.

    PubMed  Google Scholar 

  49. De Paola AA, Horowitz LN, Miyamoto MH, Pinheiro R, Ferreira DF, Terzian AB, et al. Angiographic and electrophysiologic substrates of ventricular tachycardia in chronic Chagasic myocarditis. Am J Cardiol. 1990;65:360–3.

    PubMed  Google Scholar 

  50. Sarabanda AV, Sosa E, Simoes MV, Figueiredo GL, Pintya AO, Marin-Neto JA. Ventricular tachycardia in Chagas’ disease: a comparison of clinical, angiographic, electrophysiologic and myocardial perfusion disturbances between patients presenting with either sustained or nonsustained forms. Int J Cardiol. 2005;102:9–19.

    PubMed  Google Scholar 

  51. Sosa E, Scanavacca M, D’Avila A, Bellotti G, Pilleggi F. Radiofrequency catheter ablation of ventricular tachycardia guided by nonsurgical epicardial mapping in chronic Chagasic heart disease. Pacing Clin Electrophysiol. 1999;22:128–30.

    PubMed  CAS  Google Scholar 

  52. Rochitte CE, Oliveira PF, Andrade JM, Ianni BM, Parga JR, Avila LF, et al. Myocardial delayed enhancement by magnetic resonance imaging in patients with Chagas’ disease: a marker of disease severity. J Am Coll Cardiol. 2005;46:1553–8.

    PubMed  Google Scholar 

  53. Gomes VA, Alves GF, Hadlich M, Azevedo CF, Pereira IM, Santos CR, et al. Analysis of regional left ventricular strain in patients with Chagas disease and normal left ventricular systolic function. J Am Soc Echocardiogr. 2016;29:679–88.

    PubMed  Google Scholar 

  54. Sosa E, Scanavacca M, D’Avila A, Pilleggi F. A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol. 1996;7:531–6.

    PubMed  CAS  Google Scholar 

  55. Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, et al. EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European heart rhythm association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm. 2009;6:886–933.

    PubMed  Google Scholar 

  56. Vaseghi M, Gima J, Kanaan C, Ajijola OA, Marmureanu A, Mahajan A, et al. Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up. Heart Rhythm. 2014;11:360–6.

    PubMed  Google Scholar 

  57. Cardoso RN, Macedo FY, Garcia MN, Garcia DC, Benjo AM, Aguilar D, et al. Chagas cardiomyopathy is associated with higher incidence of stroke: a meta-analysis of observational studies. J Card Fail. 2014;20:931–8.

    PubMed  Google Scholar 

  58. Samuel J, Oliveira M, Correa De Araujo RR, Navarro MA, Muccillo G. Cardiac thrombosis and thromboembolism in chronic Chagas’ heart disease. Am J Cardiol. 1983;52:147–51.

    PubMed  CAS  Google Scholar 

  59. Aras R, da Matta JA, Mota G, Gomes I, Melo A. Cerebral infarction in autopsies of chagasic patients with heart failure. Arq Bras Cardiol. 2003;81:414–3.

    PubMed  Google Scholar 

  60. Nunes MC, Barbosa MM, Ribeiro AL, Colosimo EA, Rocha MO. Left atrial volume provides independent prognostic value in patients with Chagas cardiomyopathy. J Am Soc Echocardiogr. 2009;22:82–8.

    PubMed  Google Scholar 

  61. Nunes MC, Kreuser LJ, Ribeiro AL, Sousa GR, Costa HS, Botoni FA, et al. Prevalence and risk factors of embolic cerebrovascular events associated with Chagas heart disease. Glob Heart. 2015;10:151–7.

    PubMed  Google Scholar 

  62. Sousa AS, Xavier SS, Freitas GR, Hasslocher-Moreno A. Prevention strategies of cardioembolic ischemic stroke in Chagas’ disease. Arq Bras Cardiol. 2008;91:306–10.

    PubMed  Google Scholar 

  63. Rocha MO, Nunes MC, Ribeiro AL. Morbidity and prognostic factors in chronic chagasic cardiopathy. Mem Inst Oswaldo Cruz. 2009;104(Suppl 1):159–66.

    PubMed  Google Scholar 

  64. Carod-Artal FJ, Vargas AP, Horan TA, Nunes LG. Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. Stroke. 2005;36:965–70.

    PubMed  Google Scholar 

  65. Herrera RN, Diaz de Amaya EI, Perez Aguilar RC, Joo TC, Maranon R, Berman SG, et al. Inflammatory and prothrombotic activation with conserved endothelial function in patients with chronic, asymptomatic Chagas disease. Clin Appl Thromb Hemost. 2011;17:502–7.

    PubMed  CAS  Google Scholar 

  66. Pinazo MJ, Posada EJ, Izquierdo L, Tassies D, Marques AF, de Lazzari E, et al. Altered hypercoagulability factors in patients with chronic chagas disease. Potential biomarkers of therapeutic response. PLoS Negl Trop Dis. 2016;10:e0004269.

    PubMed  PubMed Central  Google Scholar 

  67. Nisimura LM, Estato V, de Souza EM, Reis PA, Lessa MA, Castro-Faria-Neto HC, et al. Acute Chagas disease induces cerebral microvasculopathy in mice. PLoS Negl Trop Dis. 2014;8:e2998.

    PubMed  PubMed Central  Google Scholar 

  68. Dias Junior JO, da Costa Rocha MO, de Souza AC, Kreuser LJ, de Souza Dias LA, Tan TC, et al. Assessment of the source of ischemic cerebrovascular events in patients with Chagas disease. Int J Cardiol. 2014;176:1352–4.

    PubMed  Google Scholar 

  69. Lima-Costa MF, Castro-Costa E, Uchoa E, Firmo J, Ribeiro AL, Ferri CP, et al. A population-based study of the association between Trypanosoma cruzi infection and cognitive impairment in old age (the Bambui study). Neuroepidemiology. 2009;32:122–8.

    PubMed  Google Scholar 

  70. Mangone CA, Sica RE, Pereyra S, Genovese O, Segura E, Riarte A, et al. Cognitive impairment in human chronic Chagas’ disease. Arq Neuropsiquiatr. 1994;52:200–3.

    PubMed  CAS  Google Scholar 

  71. Paixao LC, Ribeiro AL, Valacio RA, Teixeira AL. Chagas disease: independent risk factor for stroke. Stroke. 2009;40:3691–4.

    PubMed  Google Scholar 

  72. Carod-Artal FJ, Vargas AP, Falcao T. Stroke in asymptomatic Trypanosoma cruzi-infected patients. Cerebrovasc Dis. 2011;31:24–8.

    PubMed  Google Scholar 

  73. Oliveira-Filho J, Viana LC, Vieira-de-Melo RM, Faical F, Torreao JA, Villar FA, et al. Chagas disease is an independent risk factor for stroke: baseline characteristics of a Chagas disease cohort. Stroke. 2005;36:2015–7.

    PubMed  Google Scholar 

  74. Nunes MC, Barbosa MM, Rocha MO. Peculiar aspects of cardiogenic embolism in patients with Chagas’ cardiomyopathy: a transthoracic and transesophageal echocardiographic study. J Am Soc Echocardiogr. 2005;18:761–7.

    Google Scholar 

  75. Cardoso R, Garcia D, Fernandes G, He LI, Lichtenberger P, Viles-Gonzalez J, et al. The prevalence of atrial fibrillation and conduction abnormalities in Chagas’ disease: a meta-analysis. J Cardiovasc Electrophysiol. 2016;27:161–9.

    PubMed  Google Scholar 

  76. Lee-Felker SA, Thomas M, Felker ER, Traina M, Salih M, Hernandez S, et al. Value of cardiac MRI for evaluation of chronic Chagas disease cardiomyopathy. Clin Radiol. 2016;71:618–7.

    PubMed  Google Scholar 

  77. Trabuco CC, Pereira de Jesus PA, Bacellar AS, Oliveira-Filho J. Successful thrombolysis in cardioembolic stroke from Chagas disease. Neurology. 2005;64:170–1.

    PubMed  Google Scholar 

  78. Cougo-Pinto PT, Dos Santos BL, Dias FA, Camilo MR, Alessio-Alves FF, Barreira CM, et al. Safety of IV thrombolysis in acute ischemic stroke related to Chagas disease. Neurology. 2013;81:1773–5.

    PubMed  Google Scholar 

  79. Rassi A Jr, Rassi A, Rassi SG. Predictors of mortality in chronic Chagas disease: a systematic review of observational studies. Circulation. 2007;115:1101–8.

    PubMed  Google Scholar 

  80. Nunes MC, Rocha MO, Ribeiro AL, Colosimo EA, Rezende RA, Carmo GA, et al. Right ventricular dysfunction is an independent predictor of survival in patients with dilated chronic Chagas’ cardiomyopathy. Int J Cardiol. 2008;127:372–9.

    Google Scholar 

  81. Dutra WO, Menezes CA, Magalhaes LM, Gollob KJ. Immunoregulatory networks in human Chagas disease. Parasite Immunol. 2014;36:377–87.

    PubMed  PubMed Central  CAS  Google Scholar 

  82. Saraiva RM, Waghabi MC, Vilela MF, Madeira FS, da Silva GM, Xavier SS, et al. Predictive value of transforming growth factor-beta1in Chagas disease: towards a biomarker surrogate of clinical outcome. Trans R Soc Trop Med Hyg. 2013;107:518–25.

    PubMed  CAS  Google Scholar 

  83. Heringer-Walther S, Moreira MC, Wessel N, Saliba JL, Silvia-Barra J, Pena JL, et al. Brain natriuretic peptide predicts survival in Chagas’ disease more effectively than atrial natriuretic peptide. Heart. 2005;91:385–7.

    PubMed  PubMed Central  CAS  Google Scholar 

  84. Lima-Costa MF, Cesar CC, Peixoto SV, Ribeiro AL. Plasma B-type natriuretic peptide as a predictor of mortality in community-dwelling older adults with Chagas disease: 10-year follow-up of the Bambui cohort study of aging. Am J Epidemiol. 2010;172:190–6.

    PubMed  Google Scholar 

  85. 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;10:173–80.

    PubMed  PubMed Central  Google Scholar 

  86. Rivero CV, Vanrell C, Cueto J, Romano P. Carvedilol (Crv) inhibits theTrypanosoma cruzi autophagic pathway affecting parasite replication and survival. ID Week Conference 2016. Abstract.

    Google Scholar 

  87. Horta AL, Leite AL, Paula CG, Figueiredo VP, Talvani A. Potential role of Carvedilol in the cardiac immune response induced by experimental infection with Trypanosoma cruzi. Biomed Res Int. 2017;2017:9205062.

    PubMed  PubMed Central  Google Scholar 

  88. Sperandio da Silva GM, Chambela MC, Sousa AS, Sangenis LH, Xavier SS, Costa AR, et al. Impact of pharmaceutical care on the quality of life of patients with Chagas disease and heart failure: randomized clinical trial. Trials. 2012;13:244.

    PubMed  Google Scholar 

  89. Mendes FS, Sousa AS, Souza FC, Pinto VL, Silva PS, Saraiva RM, et al. Effect of physical exercise training in patients with Chagas heart disease: study protocol for a randomized controlled trial (PEACH study). Trials. 2016;17:433.

    PubMed Central  Google Scholar 

  90. Roberti RR, Martinez EE, Andrade JL, Araujo VL, Brito FS, Portugal OP, et al. Chagas cardiomyopathy and captopril. Eur Heart J. 1992;13:966–70.

    PubMed  CAS  Google Scholar 

  91. Botoni FA, Poole-Wilson PA, Ribeiro AL, Okonko DO, Oliveira BM, Pinto AS, et al. A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy. Am Heart J. 2007;153:544–8.

    PubMed  Google Scholar 

  92. Bestetti RB, Otaviano AP, Cardinalli-Neto A, da Rocha BF, Theodoropoulos TA, Cordeiro JA. Effects of B-blockers on outcome of patients with Chagas’ cardiomyopathy with chronic heart failure. Int J Cardiol. 2011;151:205–8.

    PubMed  Google Scholar 

  93. Marti-Carvajal AJ, Kwong JS. Pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy. Cochrane Database Syst Rev. 2016;7:CD009077.

    PubMed  Google Scholar 

  94. Bacal F, Silva CP, Pires PV, Mangini S, Fiorelli AI, Stolf NG, et al. Transplantation for Chagas’ disease: an overview of immunosuppression and reactivation in the last two decades. Clin Transpl. 2010;24:E29–34.

    Google Scholar 

  95. Bestetti RB, Theodoropoulos TA. A systematic review of studies on heart transplantation for patients with end-stage Chagas’ heart disease. J Card Fail. 2009;15:249–55.

    PubMed  Google Scholar 

  96. Diez M, Favaloro L, Bertolotti A, Burgos JM, Vigliano C, Lastra MP, et al. Usefulness of PCR strategies for early diagnosis of Chagas’ disease reactivation and treatment follow-up in heart transplantation. Am J Transplant. 2007;7:1633–40.

    PubMed  CAS  Google Scholar 

  97. Vizzoni AG, Varela MC, Sangenis LHC, Hasslocher-Moreno AM, do Brasil PEAA, Saraiva RM. Ageing with Chagas disease: an overview of an urban Brazilian cohort in Rio de Janeiro. Parasit Vectors. 2018;11:354.

    PubMed  PubMed Central  Google Scholar 

  98. Simoes MV, Ayres EM, Santos JL, Schmidt A, Pintya AO, Maciel BC, et al. Detection of myocardial ischemia in chronic Chagas disease patients with atypic precordial pain by exercise and Holter tests. Arq Bras Cardiol. 1993;60:315–9.

    PubMed  CAS  Google Scholar 

  99. Peix A, Garcia R, Sanchez J, Cabrera LO, Padron K, Vedia O, et al. Myocardial perfusion imaging and cardiac involvement in the indeterminate phase of Chagas disease. Arq Bras Cardiol. 2013;100:114–7.

    PubMed  Google Scholar 

  100. Abuhid IM, Pedroso ER, Rezende NA. Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease. Arq Bras Cardiol. 2010;95:30–4.

    PubMed  Google Scholar 

  101. Marin-Neto JA, Marzullo P, Marcassa C, Gallo JL, Maciel BC, Bellina CR, et al. Myocardial perfusion abnormalities in chronic Chagas’ disease as detected by thallium-201 scintigraphy. Am J Cardiol. 1992;69:780–4.

    PubMed  CAS  Google Scholar 

  102. Nascimento CAS, Pacheco NP, Alves GF, Madeira FS, Costa AR, Holanda MT, et al. Total left atrial emptying fraction determined by real time 3-dimensional echocardiography is an independent predictor of new-onset atrial fibrillation in patients with Chagas disease. Heart Failure 2017 meeting. Eur J Heart Fail. 2017;19:S21. Abstract.

    Google Scholar 

  103. Nahum J, Bensaid A, Dussault C, Macron L, Clemence D, Bouhemad B, et al. Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients. Circ Cardiovasc Imaging. 2010;3:249–56.

    PubMed  Google Scholar 

  104. Cho GY, Marwick TH, Kim HS, Kim MK, Hong KS, Oh DJ. Global 2-dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol. 2009;54:618–24.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

    Roberto M. Saraiva

  2. David Geffen School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA

    Sheba Meymandi

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  1. Roberto M. Saraiva
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  2. Sheba Meymandi
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Correspondence to Roberto M. Saraiva .

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  1. Barcelona Institute for Global Health, Barcelona, Spain

    María-Jesús Pinazo Delgado

  2. Barcelona Institute for Global Health, Barcelona, Spain

    Joaquim Gascón

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Saraiva, R.M., Meymandi, S. (2020). Management of Chronic Chagasic Cardiomyopathy in Endemic and Non-endemic Countries: Challenges and Limitations. In: Pinazo Delgado, MJ., Gascón, J. (eds) Chagas Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-44054-1_9

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