title: Prevalence and Impact of Chagas Disease Among Latin American Immigrants With Nonischemic Cardiomyopathy in Los Angeles, California.
abstract: BACKGROUND
  Chagas disease is a well-known cause of cardiomyopathy in Latin America; however, 300 000 individuals are estimated to have Chagas disease in the United States. This study examined the prevalence and impact of Chagas cardiomyopathy (CCM) in a US population. We hypothesized that patients with CCM would have increased morbidity and mortality when compared with patients with non-CCM.
  
  
  RESULTS
  This is a single-center, prospective cohort study. Enrollment criteria were new diagnosis of nonischemic cardiomyopathy (left ventricular ejection fraction ≤40%) and previous residence in Latin America for at least 12 months. Serological testing for Trypanosoma cruzi was performed at enrollment. The primary end point was all-cause mortality or heart transplantation. The secondary end point was heart failure-related hospitalization. A total of 135 patients were enrolled, with a median of 43 months of follow-up. Chagas disease was diagnosed in 25 (19%) patients. The primary end point occurred in 9 patients (36%) in the CCM group and in 11 patients (10%) in the non-CCM group (hazard ratio [HR], 4.46; 95% confidence interval, 1.8-10.8; P=0.001). The secondary end point occurred in 13 patients (52%) in the CCM group and in 35 patients (32%) in the non-CCM group (HR, 2.22; 95% confidence interval, 1.2-4.2; P=0.01).
  
  
  CONCLUSIONS
  There is a high prevalence of Chagas disease among Latin American immigrants diagnosed with nonischemic cardiomyopathy in Los Angeles. Advanced CCM portends a poor prognosis and is associated with increased all-cause mortality/heart transplantation and heart failure-related hospitalization.
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.). mtraina@dhs.lacounty.gov.
authors.forename: Mahmoud I
authors.initials: MI
authors.lastname: Traina
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Sanchez
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Salvador
authors.initials: S
authors.lastname: Hernandez
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Jason S
authors.initials: JS
authors.lastname: Bradfield
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Mohamed R
authors.initials: MR
authors.lastname: Labedi
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Tarik A
authors.initials: TA
authors.lastname: Ngab
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Frank
authors.initials: F
authors.lastname: Steurer
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Susan P
authors.initials: SP
authors.lastname: Montgomery
authors.affiliation: From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
authors.forename: Sheba K
authors.initials: SK
authors.lastname: Meymandi
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D009202:Cardiomyopathies / Q000208:ethnology*; D014355:Chagas Disease / Q000208:ethnology*; D054242:Emigrants and Immigrants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies
keywords: Chagas cardiomyopathy; cardiomyopathies; heart failure; mortality; prognosis