title: Risk progression to chronic Chagas cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction.
abstract: BACKGROUND
  Polymerase chain reaction (PCR) allows detection of Trypanosoma cruzi in blood throughout the course of Chagas' disease.
  
  
  OBJECTIVE
  To determine whether T cruzi DNA detected by PCR is associated with progression to chronic Chagas cardiomyopathy.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A tertiary care centre in Argentina.
  
  
  METHODS
  56 consecutive patients with chronic T cruzi infection.
  
  
  METHODS
  Clinical examination, ECG, and Doppler echocardiography were carried out at baseline and at the end of the follow up. Detection of T cruzi DNA by PCR amplifying a nuclear sequence was undertaken in all patients at baseline.
  
  
  METHODS
  Progression was defined as death from chronic cardiomyopathy or the presence of a new ECG or left ventricular echocardiographic abnormality at the end of follow up.
  
  
  RESULTS
  The 56 patients (21 male, 35 female; mean (SD) age, 56.0 (11.3) years) were followed for a mean 936.3 (244.39) days. Progression to cardiomyopathy was detected in 12 patients (21.4%). Three of these patients died after baseline evaluation. Univariate analysis showed that a positive PCR (relative risk 4.09, 95% confidence interval (CI) 1.60 to 9.85) and male sex (5.00, 95% CI 1.65 to 15.73) were associated with progression. Multivariable logistic regression indicated that both sex and PCR were independent variables affecting the outcome.
  
  
  CONCLUSIONS
  In a cohort of seropositive individuals, patients with T cruzi DNA detected by PCR and male patients were at higher risk of progression. These results highlight the importance of T cruzi in the pathophysiology of chronic cardiomyopathy.
authors.affiliation: Internal Medicine Training Programme, Department of Education, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina. anabasquiera@arnet.com.ar
authors.forename: A L
authors.initials: AL
authors.lastname: Basquiera
authors.forename: A
authors.initials: A
authors.lastname: Sembaj
authors.forename: A M
authors.initials: AM
authors.lastname: Aguerri
authors.forename: M
authors.initials: M
authors.lastname: Omelianiuk
authors.forename: S
authors.initials: S
authors.lastname: Guzmán
authors.forename: J
authors.initials: J
authors.lastname: Moreno Barral
authors.forename: T F
authors.initials: TF
authors.lastname: Caeiro
authors.forename: R J
authors.initials: RJ
authors.lastname: Madoery
authors.forename: O A
authors.initials: OA
authors.lastname: Salomone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002598:Chagas Cardiomyopathy / Q000175:diagnosis / Q000469:parasitology* / Q000503:physiopathology; D015331:Cohort Studies; D016054:DNA, Protozoan / Q000032:analysis; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000469:parasitology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis / Q000469:parasitology* / Q000503:physiopathology; D016133:Polymerase Chain Reaction / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D014349:Trypanosoma cruzi / Q000302:isolation & purification*
chemical_list: D016054:DNA, Protozoan