title: Chagas cardiomyopathy in the context of the chronic disease transition.
abstract: BACKGROUND
  Patients with Chagas disease have migrated to cities, where obesity, hypertension and other cardiac risk factors are common.
  
  
  RESULTS
  The study included adult patients evaluated by the cardiology service in a public hospital in Santa Cruz, Bolivia. Data included risk factors for T. cruzi infection, medical history, physical examination, electrocardiogram, echocardiogram, and contact 9 months after initial data collection to ascertain mortality. Serology and PCR for Trypanosoma cruzi were performed. Of 394 participants, 251 (64%) had confirmed T. cruzi infection by serology. Among seropositive participants, 109 (43%) had positive results by conventional PCR; of these, 89 (82%) also had positive results by real time PCR. There was a high prevalence of hypertension (64%) and overweight (body mass index [BMI] >25; 67%), with no difference by T. cruzi infection status. Nearly 60% of symptomatic congestive heart failure was attributed to Chagas cardiomyopathy; mortality was also higher for seropositive than seronegative patients (p = 0.05). In multivariable models, longer residence in an endemic province, residence in a rural area and poor housing conditions were associated with T. cruzi infection. Male sex, increasing age and poor housing were independent predictors of Chagas cardiomyopathy severity. Males and participants with BMI </=25 had significantly higher likelihood of positive PCR results compared to females or overweight participants.
  
  
  CONCLUSIONS
  Chagas cardiomyopathy remains an important cause of congestive heart failure in this hospital population, and should be evaluated in the context of the epidemiological transition that has increased risk of obesity, hypertension and chronic cardiovascular disease.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Alicia I
authors.initials: AI
authors.lastname: Hidron
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Juan
authors.initials: J
authors.lastname: Justiniano
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Blackstock
authors.forename: Carlos
authors.initials: C
authors.lastname: Lafuente
authors.forename: Walter
authors.initials: W
authors.lastname: Selum
authors.forename: Martiza
authors.initials: M
authors.lastname: Calderon
authors.forename: Manuela
authors.initials: M
authors.lastname: Verastegui
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Ferrufino
authors.forename: Eduardo
authors.initials: E
authors.lastname: Valencia
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Tornheim
authors.forename: Seth
authors.initials: S
authors.lastname: O'Neal
authors.forename: Robert
authors.initials: R
authors.lastname: Comer
authors.forename: Gerson
authors.initials: G
authors.lastname: Galdos-Cardenas
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000913:Antibodies, Protozoan / Q000097:blood; D001838:Bolivia / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D002908:Chronic Disease; D016054:DNA, Protozoan / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012307:Risk Factors; D014349:Trypanosoma cruzi / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D016054:DNA, Protozoan