Incidence and Predictors of Progression to Chagas Cardiomyopathy: Long-Term Follow-Up of Trypanosoma cruzi-Seropositive Individuals

Imagem de Miniatura
Arquivos
art_NUNES_Incidence_and_Predictors_of_Progression_to_Chagas_Cardiomyopathy_2021.PDF (558.21 KB)
Citações na Scopus
18
Tipo de produção
article
Data de publicação
2021
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
NUNES, Maria Carmo P.
SILVA, Jose Luiz P.
MARTINS, Larissa Natany A.
OLIVEIRA, Claudia Di Lorenzo
CARDOSO, Clareci Silva
BRITO, Bruno Oliveira de Figueiredo
FERREIRA, Ariela Mota
BIERRENBACH, Ana Luiza
Citação
CIRCULATION, v.144, n.19, p.1553-1566, 2021
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: There are few contemporary cohorts of Trypanosoma cruzi-seropositive individuals, and the basic clinical epidemiology of Chagas disease is poorly understood. Herein, we report the incidence of cardiomyopathy and death associated with T. cruzi seropositivity. Methods: Participants were selected in blood banks at 2 Brazilian centers. Cases were defined as T. cruzi-seropositive blood donors. T. cruzi-seronegative controls were matched for age, sex, and period of donation. Patients with established Chagas cardiomyopathy were recruited from a tertiary outpatient service. Participants underwent medical examination, blood collection, ECG, and echocardiogram at enrollment (2008-2010) and at follow-up (2018-2019). The primary outcomes were all-cause mortality and development of cardiomyopathy, defined as the presence of a left ventricular ejection fraction <50% or QRS complex duration <greater than or equal to>120 ms, or both. To handle loss to follow-up, a sensitivity analysis was performed using inverse probability weights for selection. Results: We enrolled 499 T. cruzi-seropositive donors (age 4810 years, 52% male), 488 T. cruzi-seronegative donors (age 49 +/- 10 years, 49% male), and 101 patients with established Chagas cardiomyopathy (age 48 +/- 8 years, 59% male). The mortality in patients with established cardiomyopathy was 80.9 deaths/1000 person-years (py) (54/101, 53%) and 15.1 deaths/1000 py (17/114, 15%) in T. cruzi-seropositive donors with cardiomyopathy at baseline. Among T. cruzi-seropositive donors without cardiomyopathy at baseline, mortality was 3.7 events/1000 py (15/385, 4%), which was no different from T. cruzi-seronegative donors with 3.6 deaths/1000 py (17/488, 3%). The incidence of cardiomyopathy in T. cruzi-seropositive donors was 13.8 (95% CI, 9.5-19.6) events/1000 py (32/262, 12%) compared with 4.6 (95% CI, 2.3-8.3) events/1000 py (11/277, 4%) in seronegative controls, with an absolute incidence difference associated with T. cruzi seropositivity of 9.2 (95% CI, 3.6-15.0) events/1000 py. T. cruzi antibody level at baseline was associated with development of cardiomyopathy (adjusted odds ratio, 1.4 [95% CI, 1.1-1.8]). Conclusions: We present a comprehensive description of the natural history of T. cruzi seropositivity in a contemporary patient population. The results highlight the central importance of anti-T. cruzi antibody titer as a marker of Chagas disease activity and risk of progression.
Palavras-chave
Chagas cardiomyopathy, Chagas disease, disease progression, mortality, serology, Trypanosoma cruzi
URI
https://observatorio.fm.usp.br/handle/OPI/44451
Referências
  1. [Anonymous], 2015, Wkly Epidemiol Rec, V90, P33
  2. Basquiera AL, 2003, HEART, V89, P1186, DOI 10.1136/heart.89.10.1186
  3. Benvenuti LA, 2008, ANN TROP MED PARASIT, V102, P481, DOI 10.1179/136485908X311740
  4. Bern C, 2020, CLIN MICROBIOL REV, V33, DOI 10.1128/CMR.00023-19
  5. Britto CC, 2009, MEM I OSWALDO CRUZ, V104, P122, DOI 10.1590/S0074-02762009000900018
  6. Buss LF, 2021, REV INST MED TROP SP, V63, DOI [10.1590/s1678-9946202163031, 10.1590/S1678-9946202163031]
  7. Buss LF, 2020, PLOS NEGLECT TROP D, V14, DOI 10.1371/journal.pntd.0008787
  8. Bustamante JM, 2007, PARASITOL RES, V100, P1407, DOI 10.1007/s00436-006-0425-3
  9. Capuani L, 2014, CAD SAUDE PUBLICA, V30, P1623, DOI 10.1590/0102-311X00024914
  10. Cardoso CS, 2018, PLOS NEGLECT TROP D, V12, DOI 10.1371/journal.pntd.0006814
  11. Carpenter J., 2012, MULTIPLE IMPUTATION
  12. Chadalawada S, 2020, JAMA NETW OPEN, V3, DOI 10.1001/jamanetworkopen.2020.15072
  13. Costa MFFLE, 2001, INT J EPIDEMIOL, V30, P887, DOI 10.1093/ije/30.4.887
  14. Coura J R, 1985, Mem Inst Oswaldo Cruz, V80, P73, DOI 10.1590/S0074-02761985000100011
  15. ESPINOSA R, 1985, INT J CARDIOL, V8, P45, DOI 10.1016/0167-5273(85)90262-1
  16. Georg I, 2017, PLOS NEGLECT TROP D, V11, DOI 10.1371/journal.pntd.0005796
  17. Hasslocher-Moreno AM, 2020, TROP MED INFECT DIS, V5, DOI 10.3390/tropicalmed5020076
  18. JONES EM, 1993, AM J TROP MED HYG, V48, P348, DOI 10.4269/ajtmh.1993.48.348
  19. Kristman V, 2004, EUR J EPIDEMIOL, V19, P751, DOI 10.1023/B:EJEP.0000036568.02655.f8
  20. Lang RM, 2015, J AM SOC ECHOCARDIOG, V28, P1, DOI 10.1016/j.echo.2014.10.003
  21. LARANJA FS, 1956, CIRCULATION, V14, P1035, DOI 10.1161/01.CIR.14.6.1035
  22. MAGUIRE JH, 1987, CIRCULATION, V75, P1140, DOI 10.1161/01.CIR.75.6.1140
  23. Marcolino MS, 2014, REV ASSOC MED BRAS, V60, P236, DOI 10.1590/1806-9282.60.03.012
  24. Martins-Melo FR, 2014, ACTA TROP, V130, P167, DOI 10.1016/j.actatropica.2013.10.002
  25. Moolani Y, 2012, PLOS NEGLECT TROP D, V6, DOI 10.1371/journal.pntd.0001499
  26. Morillo CA, 2015, NEW ENGL J MED, V373, P1295, DOI 10.1056/NEJMoa1507574
  27. MOTA EA, 1990, AM J TROP MED HYG, V42, P429, DOI 10.4269/ajtmh.1990.42.429
  28. Nogueira PM, 2015, J EXTRACELL VESICLES, V4, DOI 10.3402/jev.v4.28734
  29. Nunes MCP, 2009, J AM SOC ECHOCARDIOG, V22, P82, DOI 10.1016/j.echo.2008.11.015
  30. Nunes MCP, 2018, CIRCULATION, V138, pE169, DOI 10.1161/CIR.0000000000000599
  31. Nunes MCP, 2013, J AM COLL CARDIOL, V62, P767, DOI 10.1016/j.jacc.2013.05.046
  32. Nunes MCP, 2012, EXPERT REV CARDIOVAS, V10, P1173, DOI [10.1586/erc.12.111, 10.1586/ERC.12.111]
  33. Dias JCP, 2016, REV SOC BRAS MED TRO, V49, P3, DOI 10.1590/0037-8682-0505-2016
  34. Prata A, 2001, Lancet Infect Dis, V1, P92, DOI 10.1016/S1473-3099(01)00065-2
  35. Ribeiro AL, 2013, PLOS NEGLECT TROP D, V7, DOI 10.1371/journal.pntd.0002078
  36. Ribeiro AL, 2012, NAT REV CARDIOL, V9, P576, DOI 10.1038/nrcardio.2012.109
  37. Ribeiro ALP, 2014, J AM HEART ASSOC, V3, DOI 10.1161/JAHA.113.000632
  38. Ribeiro V, 2020, INT J PARASITOL-DRUG, V12, P7, DOI 10.1016/j.ijpddr.2019.11.004
  39. Ruiz-Lancheros E, 2019, BIRKHAUSER ADV INFEC, P323, DOI 10.1007/978-3-030-00054-7_16
  40. Sabino EC, 2013, CIRCULATION, V127, P1105, DOI 10.1161/CIRCULATIONAHA.112.123612
  41. Viotti R, 2014, ANTIMICROB AGENTS CH, V58, P635, DOI 10.1128/AAC.01662-13
  42. Viotti R, 2006, ANN INTERN MED, V144, P724, DOI 10.7326/0003-4819-144-10-200605160-00006
  43. Vizzoni AG, 2018, PARASITE VECTOR, V11, DOI 10.1186/s13071-018-2929-y
  44. WHO/PAHO, 2016, NEGL INF DIS AM SUCC

Coleções
Artigos e Materiais de Revistas Científicas - FM/MIP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/03
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - LIM/46