title: Electrocardiographic and echocardiographic abnormalities in Chagas disease: findings in residents of rural Bolivian communities hyperendemic for Chagas disease.
abstract: BACKGROUND
  Chagas disease is a neglected and preventable tropical disease that causes significant cardiac morbidity and mortality in Latin America.
  
  
  OBJECTIVE
  This study sought to describe cardiac findings among inhabitants of rural communities of the Bolivian Chaco.
  
  
  METHODS
  The cardiac study drew participants from an epidemiologic study in 7 indigenous Guarani communities. All infected participants 10 years or older were asked to undergo a brief physical examination and 12-lead electrocardiogram (ECG). A subset had echocardiograms. ECG and echocardiograms were read by 1 or more cardiologists.
  
  
  RESULTS
  Of 1,137 residents 10 years or older, 753 (66.2%) had Trypanosoma cruzi infection. Cardiac evaluations were performed for 398 infected participants 10 years or older. Fifty-five participants (13.8%) had 1 or more ECG abnormalities suggestive of Chagas cardiomyopathy. The most frequent abnormalities were bundle branch blocks in 42 (11.3%), followed by rhythm disturbances or ventricular ectopy in 13 (3.3%), and atrioventricular blocks (AVB) in 10 participants (2.6%). The prevalence of any abnormality rose from 1.1% among those 10 to 19 years old to 14.2%, 17.3%, and 26.4% among those 20 to 39, 40 to 59, and older than 60 years, respectively. First-degree AVB was seen most frequently in participants 60 years or older, but the 4 patients with third-degree AVB were all under 50 years old. Eighteen and 2 participants had a left ventricular ejection fraction of 40% to 54% and <40%, respectively. An increasing number of ECG abnormalities was associated with progressively larger left ventricular end-diastolic dimensions and lower left ventricular ejection fraction.
  
  
  CONCLUSIONS
  We found a high prevalence of ECG abnormalities and substantial evidence of Chagas cardiomyopathy. Programs to improve access to basic cardiac care (annual ECG, antiarrhythmics, pacemakers) could have an immediate impact on morbidity and mortality in these highly endemic communities.
authors.affiliation: Division of Cardiology, Hartford Hospital and University of Connecticut School of Medicine, Hartford, CT, USA. Electronic address: antoinefernandezt@hotmail.com.
authors.forename: Antonio B
authors.initials: AB
authors.lastname: Fernandez
authors.affiliation: School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Maria Carmo P
authors.initials: MC
authors.lastname: Nunes
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Eva H
authors.initials: EH
authors.lastname: Clark
authors.affiliation: Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Samuels
authors.affiliation: Centro de Salud, Eity, Gutierrez, Bolivia.
authors.forename: Silvio
authors.initials: S
authors.lastname: Menacho
authors.affiliation: Hospital San Juan de Dios, Santa Cruz, Bolivia.
authors.forename: Jesus
authors.initials: J
authors.lastname: Gomez
authors.affiliation: Hospital Municipal Camiri, Camiri, Bolivia.
authors.forename: Ricardo W
authors.initials: RW
authors.lastname: Bozo Gutierrez
authors.affiliation: Department of Cardiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Crawford
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D054537:Atrioventricular Block / Q000453:epidemiology*; D001838:Bolivia / Q000453:epidemiology; D002037:Bundle-Branch Block / Q000453:epidemiology* / Q000503:physiopathology; D002598:Chagas Cardiomyopathy / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D014355:Chagas Disease / Q000453:epidemiology; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018879:Ventricular Premature Complexes / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult