title: Stroke history and Chagas disease are independent predictors of silent cerebral microembolism in patients with congestive heart failure.
abstract: BACKGROUND
  Chagas disease is endemic in South and Central America, where 18 million individuals are infected by Trypanosoma cruzi, causing congestive heart failure (CHF) and cardioembolic stroke. Transcranial Doppler (TCD) is able to detect real-time microembolic signals (MES) to the brain vessels and may represent a surrogate marker of stroke risk. We aimed to determine predictors of MES in a population of patients with CHF.
  
  
  METHODS
  Consecutive CHF patients from a university-based cardiomyopathy clinic underwent TCD recording of the middle cerebral artery for 60 min by a single investigator who was blinded to all clinical data including cardiomyopathy etiology. Predictors of MES were sought by multivariable logistic regression analysis.
  
  
  RESULTS
  From April 2004 to February 2009, 144 patients were studied, including 62 (44.6%) patients with Chagas disease. MES were detected in 9 (6.2%) patients and were more frequent in patients with Chagas disease than in patients with other causes of CHF (12.9 vs. 1.2%, p = 0.005). In multivariate analysis corrected for age and left-ventricular ejection fraction, predictors of MES were Chagas disease (odds ratio = 1.15, 95% confidence interval = 1.05-1.26, p = 0.004) and stroke history (odds ratio = 1.27, 95% confidence interval = 1.08-1.50, p = 0.005).
  
  
  CONCLUSIONS
  Chagas disease and stroke history are risk factors for MES independent of cardiac disease severity. Other mechanisms besides structural cardiac disease may be operative, increasing embolic risk in Chagas disease.
authors.affiliation: Cardiomyopathy Clinic, Hospital Universitário Prof. Edgar Santos, Federal University of Bahia, Rua Waldemar Falcão 2106, Salvador, Brazil.
authors.forename: Pedro A P
authors.initials: PA
authors.lastname: Jesus
authors.forename: Iuri
authors.initials: I
authors.lastname: Neville
authors.forename: Carolina
authors.initials: C
authors.lastname: Cincurá
authors.forename: Daniela F
authors.initials: DF
authors.lastname: Menezes
authors.forename: Rodrigo M
authors.initials: RM
authors.lastname: Vieira-de-Melo
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Lacerda
authors.forename: Leila C
authors.initials: LC
authors.lastname: Viana
authors.forename: Davidson F
authors.initials: DF
authors.lastname: Pereira
authors.forename: Valter
authors.initials: V
authors.lastname: Ribeiro-dos-Santos
authors.forename: Francisco J F B
authors.initials: FJ
authors.lastname: Reis
authors.forename: Cristiano
authors.initials: C
authors.lastname: Macedo
authors.forename: Jamary
authors.initials: J
authors.lastname: Oliveira-Filho
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D002560:Cerebrovascular Circulation; D002598:Chagas Cardiomyopathy / Q000209:etiology*; D014355:Chagas Disease / Q000150:complications*; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006785:Hospitals, University; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial