title: Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study.
abstract: BACKGROUND
  Chagas disease cardiomyopathy is a common form of dilated cardiomyopathy worldwide, and an important cause of stroke in Latin America. The long-term cumulative risk of ischemic cerebrovascular event (ICE) and its relation to left ventricular (LV) dysfunction have not been determined. The aims of this study were to describe the incidence and to evaluate the effect of LV ejection fraction on the risk for ICE in patients with Chagas cardiomyopathy.
  
  
  METHODS
  A total of 213 consecutive patients with Chagas disease and LV systolic dysfunction, 131 males, mean age 48+/-12 years, were prospectively enrolled. The use of anticoagulation was based on clinical indications. The end point was ICE, which included fatal or nonfatal stroke and transient ischemic attack. Risk factors for events were assessed by Cox proportional-hazards analysis.
  
  
  RESULTS
  Mean follow-up was 36 months; 69 patients died and seven underwent cardiac transplantation. The overall incidence of ICE was 2.67 events per 100 patient/years. Independent risk factors for ICE included LV ejection fraction (HR 0.95, 95% CI 0.91 to 0.99, p=0.009) and left atrial volume corrected for body surface area (HR 1.04, 95% CI 1.01 to 1.07, p=0.007), which persisted after adjustment for anticoagulation use. Patients with ejection fractions<or=35% had a relative risk of events of 3.41, as compared with the other patients. The presence of apical aneurysm or thrombus, age, and history of previous stroke were not an independent long-term risk for ICE.
  
  
  CONCLUSIONS
  In patients with Chagas cardiomyopathy, the annual incidence of ICE is low. Left ventricular ejection fraction and indexed left atrial volume appear to be independently associated with these events.
authors.affiliation: School of Medicine, Federal University of Minas Gerais, and ECOCENTER, Hospital Socor, Belo Horizonte, MG, Brazil. mcarmo@waymail.com.br
authors.forename: Maria Carmo P
authors.initials: MC
authors.lastname: Nunes
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Barbosa
authors.forename: Antônio Luiz P
authors.initials: AL
authors.lastname: Ribeiro
authors.forename: Felipe Batista L
authors.initials: FB
authors.lastname: Barbosa
authors.forename: Manoel O C
authors.initials: MO
authors.lastname: Rocha
mesh_terms: D000367:Age Factors; D002545:Brain Ischemia / Q000209:etiology* / Q000503:physiopathology*; D002598:Chagas Cardiomyopathy / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors