Occurrence of Stroke and Reduced Ejection Fraction in Patients with Chagas Disease

Keywords
Chagas Disease; Chagas Cardiomyopathy; Stroke; Stroke Volume

Palavras-chave
Doença de Chagas; Cardiomiopatia Chagásica; Acidente Vascular Cerebral; Volume Sistólico

Keywords
Chagas Disease; Chagas Cardiomyopathy; Stroke; Stroke Volume

Palavras-chave
Doença de Chagas; Cardiomiopatia Chagásica; Acidente Vascular Cerebral; Volume Sistólico

To the Editor

Chagas disease (CD) is a well-defined risk factor for stroke.¹ But the prognostic significance of stroke prevalence in left ventricular ejection fraction (LVEF) reduced compared to preserved LVEF in patients with heart failure and with CD, is still poorly known.²

There are studies that demonstrate the association of stroke with CD and reduced LVEF³ and there are studies that refute this association.⁴ In a cross-sectional study involving 85 chagasic patients with a mean age of 61.8 ± 9.3 years, 71.8% with heart failure and 96.5% of black race, patients were compared with LVEF ≤ 40% and LVEF > 40% to evaluate stroke occurrence in patients with CD and reduced LVEF. It was shown that LVEF ≤ 40% (OR 4.37: 1.65-11.63; p = 0.003) was an independent predictor for stroke compared to patients with preserved LVEF. There was also a high prevalence (50%) of CVA, which was obtained by cranial tomography, a number close to a cohort of 41.6% in the same town.⁵ There were no hemorrhagic strokes and there was also no significant relationship between fibrillation atrial and stroke, this data can be explained by the use of oral anticoagulants in these patients. In addition, 54.8% of silent vascular accidents were detected in patients who had no history of stroke. The high prevalence of stroke in this study with chagasic patients may have occurred because all patients were evaluated with cranial tomography, contrary to other studies, which generally use clinical and/or radiological findings as diagnostic criteria for stroke^1,4 and do not usually evaluate silent cerebral infarction.⁴ Data suggest that reduced LVEF is associated with stroke, confirmed by cranial tomography and may be an independent predictor of embolic events in this population.

References

• ¹ Carod-Artal FJ, Vargas AP, Horan TA, Nunes LG. Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. Stroke. 2005;36(5):965-70. doi: 10.1161/01.STR.0000163104.92943.50.
  » https://doi.org/10.1161/01.STR.0000163104.92943.50
• ² 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(12):931-8. doi: 10.1016/j.cardfail.2014.09.003.
  » https://doi.org/10.1016/j.cardfail.2014.09.003
• ³ Nunes MC, Barbosa MM, Ribeiro AL, Barbosa FB, Rocha MO. Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study. J Neurol Sci. 2009;278(1-2):96-101. doi: 10.1016/j.jns.2008.12.015.
  » https://doi.org/10.1016/j.jns.2008.12.015
• ⁴ 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(3):151-7. doi: 10.1016/j.gheart.2015.07.006.
  » https://doi.org/10.1016/j.gheart.2015.07.006
• ⁵ da Matta JA, Aras R Jr, de Macedo CR, da Cruz CG, Netto EM. Stroke correlates in Chagasic and non-Chagasic cardiomyopathies. PLoS One. 2012;7(4):e35116. doi: 10.1371/journal.pone.0035116.
  » https://doi.org/10.1371/journal.pone.0035116

Publication Dates

• Publication in this collection
  Mar 2018

History

• Received
  29 Sept 2017
• Reviewed
  18 Oct 2017
• Accepted
  18 Oct 2017