'Significant' Risk of Cardiomyopathy With Chagas Disease

By Will Boggs MD

September 14, 2020

NEW YORK (Reuters Health) - Patients with the acute phase or indeterminate chronic form of Chagas disease face a "significant" cumulative risk of developing chronic cardiomyopathy, according to a new systematic review.

"Although some patients with the indeterminate form of chronic Chagas disease can remain free of cardiac injury for decades, the study showed a significant annual risk of cardiomyopathy in endemic areas," said Dr. Andres F. Henao-Martinez of the University of Colorado Anschutz Medical Campus, in Aurora.

"Since there is not a good predictor of who will develop cardiomyopathy, we must assess patients with the indeterminate form or acute phase more urgently for vector control and therapy," he told Reuters Health by email.

Chronic Chagas cardiomyopathy is the primary factor associated with morbidity in patients with Chagas disease, and diagnosis and treatment of patients with acute Chagas infection or the indeterminate chronic form of Chagas disease likely decreases the risk of cardiomyopathy, vertical transmission, and death. There are few data regarding the risk of cardiomyopathy and the factors associated with it.

Dr. Henao-Martinez and colleagues estimated progression rates to cardiomyopathy among patients with these two forms of Chagas disease in their systematic review and meta-analysis of 32 studies.

Among patients with indeterminate chronic Chagas infection, the pooled estimated annual rate of development of chronic Chagas cardiomyopathy was 1.9%, with cumulative probabilities of experiencing a cardiac event of approximately 17% at 10 years and 31% at 20 years.

The annual rate of cardiomyopathy development was significantly lower among patients who received antiparasitic treatment (1.0%) than among patients who did not (2.3%), the researchers report in JAMA Network Open.

For patients with acute Chagas infection, the pooled estimated annual rate of development of chronic Chagas cardiomyopathy was 4.6%, with a cumulative probability of a cardiac event at 10 years of approximately 40%, in studies with follow-up periods beyond six months.

There were insufficient individual data to perform subgroup analyses by age, type of study, or receipt of antitrypanosomal treatment among patients with acute infection.

"The high annual cardiomyopathy risk in endemic areas among patients with acute or asymptomatic chronic Chagas disease is pressing and compels a quick cardiac evaluation and assessment for antitrypanosomal therapy from physicians and other healthcare providers," Dr. Henao-Martinez said.

SOURCE: https://bit.ly/3bg9xgE JAMA Network Open, online August 31, 2020.