title: Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease.
abstract: OBJECTIVE
  Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. American trypanosomiasis, Chagas disease (CD), is a major public health problem in South America. We sought to evaluate prevalence of vascular risk factors for stroke in patients with stroke caused by CD.
  
  
  METHODS
  Ninety-four consecutive CD stroke patients and 150 consecutive nonchagasic stroke patients were studied. CD was confirmed when both immunofluorescence and hemagglutination serology were positive. Data collected included age, sex, vascular risk factors, diagnostic stroke subtype (TOAST classification), and echocardiography findings. Fasting plasma levels of protein C, protein S, antithrombin III, homocysteine, activated protein C resistance, IgG anticardiolipin antibodies, lupus anticoagulant, and genetic tests for the factor V Leiden and the C677T methylene tetrahydrofolate reductase gene mutation were determined.
  
  
  RESULTS
  CD patients had a mean age of 56.31 years compared with 61.59 years for non-CD stroke patients (P=0.0002). Cardioembolism occurred in 56.38% of CD stroke patients compared with 9.33% in controls (P=0.000), whereas atherothrombotic strokes occurred in 8.51% of CD strokes versus 20% in controls (P=0.016), and small-vessel stroke in 9.57% of CD stroke patients versus 34.67% in controls (P=0.000). Apical aneurysm (37.23% versus 0.67%; OR, 88.39), left ventricular dilatation (23.4% versus 5.33%; OR, 5.42), mural thrombus (11.7 versus 2%; OR, 6.49) and abnormal electrocardiography (ECG) (66% versus 23.33%; OR, 2.87) were significantly higher in the group of chagasic stroke patients. No statistical differences were observed in thrombophilia between both groups. The significant variables that predicted CD stroke patients on a stepwise logistical regression model were apical aneurysm, cardiac insufficiency, ECG arrhythmia, female gender, and hypertension.
  
  
  CONCLUSIONS
  Chagasic cardiomyopathy is independently associated with ischemic stroke, whereas hypercoagulable states do not appear to be major contributors to the excess stroke risk seen in patients with CD.
authors.affiliation: Department of Neurology, The Sarah Network of Hospitals of Rehabilitation, Sarah Hospital, Brasilia DF, Brazil. javier@bsb.sarah.br
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Carod-Artal
authors.forename: Antonio Pedro
authors.initials: AP
authors.lastname: Vargas
authors.forename: Thomas Anthony
authors.initials: TA
authors.lastname: Horan
authors.forename: Luiz Guillerme Nadal
authors.initials: LG
authors.lastname: Nunes
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology*; D002598:Chagas Cardiomyopathy / Q000150:complications* / Q000175:diagnosis; D014355:Chagas Disease / Q000150:complications / Q000175:diagnosis; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D019851:Thrombophilia / Q000175:diagnosis; D014463:Ultrasonography