title: Ten-year incidence of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-seropositive former blood donors.
abstract: BACKGROUND
  Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-infected persons.
  
  
  RESULTS
  We performed a retrospective cohort study among initially healthy blood donors with an index T cruzi-seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of São Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499 T cruzi seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488 T cruzi seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to T cruzi infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction <50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (P<0.01) with male sex, a history of abnormal ECG, and the presence of an S3 heart sound.
  
  
  CONCLUSIONS
  There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic T cruzi-seropositive blood donors, although disease was mild at diagnosis.
authors: Department of Infectious Disease and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil.
authors: Ester C
authors: EC
authors: Sabino
authors: Antonio L
authors: AL
authors: Ribeiro
authors: Vera M C
authors: VM
authors: Salemi
authors: Claudia
authors: C
authors: Di Lorenzo Oliveira
authors: Andre P
authors: AP
authors: Antunes
authors: Marcia M
authors: MM
authors: Menezes
authors: Barbara M
authors: BM
authors: Ianni
authors: Luciano
authors: L
authors: Nastari
authors: Fabio
authors: F
authors: Fernandes
authors: Giuseppina M
authors: GM
authors: Patavino
authors: Vandana
authors: V
authors: Sachdev
authors: Ligia
authors: L
authors: Capuani
authors: Cesar
authors: C
authors: de Almeida-Neto
authors: Danielle M
authors: DM
authors: Carrick
authors: David
authors: D
authors: Wright
authors: Katherine
authors: K
authors: Kavounis
authors: Thelma T
authors: TT
authors: Goncalez
authors: Anna Barbara
authors: AB
authors: Carneiro-Proietti
authors: Brian
authors: B
authors: Custer
authors: Michael P
authors: MP
authors: Busch
authors: Edward L
authors: EL
authors: Murphy
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D001782:Blood Donors; D001938:Brazil / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000097:blood* / Q000453:epidemiology* / Q000469:parasitology; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014349:Trypanosoma cruzi / Q000302:isolation & purification*; D055815:Young Adult
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