Chagas Cardiomyopathy: Usefulness of EKG and Echocardiogram in a Non-Endemic Country.
BACKGROUND
Chagas disease (CD) is a major cause of cardiomyopathy in Latin America, and migration movements have now spread the disease worldwide. However, data regarding Chagas cardiomyopathy (CC) and the usefulness of echocardiography in non endemic countries are still scarce.


RESULTS
We selected 485 patients in the chronic phase of CD from two Spanish settings. Data from physical examination, electrocardiogram (EKG), x-ray, and two dimensional transthoracic echocardiogram were recorded. Trypanosoma cruzi DNA was assessed by PCR in peripheral blood. Patients were stratified according to the Kuschnir classification and a combination of echocardiogram and electrocardiogram findings. Patients mainly came from Bolivia (459; 94.6%). One hundred and forty three patients (31.5%) had at least one electrocardiogram abnormality. Twenty seven patients (5.3%) had an abnormal echocardiography. Patients with abnormal echocardiography were older (47 (IQR 38-57) years vs 41 (IQR 38-57) years); p = 0.019) and there was a greater proportion of males (66.7% vs 29.7%); p<0.001). Among echocardiographic variables, diastolic dysfunction was associated with poor cardiac status. In the multivariate analysis, abnormal EKG and gender were associated with abnormal echocardiography. Echocardiography may be spared for males under 30 and females under 45 years old with normal EKG as the likelihood of having an abnormal echocardiography is minimal. Association between T. cruzi DNA in the peripheral blood and cardiac involvement was not observed.


CONCLUSIONS
CC rates in the studied population are low. Age and sex are important determinants for the development of CC, and with the EKG should guide echocardiogram performance.
Tropical Medicine Unit, Infectious Disease Department. PROSICS (International Health Program of the Catalan Health Institute), Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Adrián
A
Sánchez-Montalvá
Tropical Medicine Unit, Infectious Disease Department. PROSICS (International Health Program of the Catalan Health Institute), Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Fernando
F
Salvador
Cardiology Department, Cardiac Imaging Department, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
José
J
Rodríguez-Palomares
Microbiology Department, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Elena
E
Sulleiro
Tropical Medicine Unit, Infectious Disease Department. PROSICS (International Health Program of the Catalan Health Institute), Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Augusto
A
Sao-Avilés
North Metropolitan International Health Unit, PROSICS (International Health Program of the Catalan Health Institute), Universitat Autònoma de Barcelona, Barcelona, Spain.
Sílvia
S
Roure
North Metropolitan International Health Unit, PROSICS (International Health Program of the Catalan Health Institute), Universitat Autònoma de Barcelona, Barcelona, Spain.
Lluís
L
Valerio
Cardiology Department, Cardiac Imaging Department, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Arturo
A
Evangelista
Tropical Medicine Unit, Infectious Disease Department. PROSICS (International Health Program of the Catalan Health Institute), Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Israel
I
Molina
D000328:Adult; D000367:Age Factors; D001838:Bolivia; D002598:Chagas Cardiomyopathy / Q000000981:diagnostic imaging* / Q000469:parasitology* / Q000473:pathology; D016054:DNA, Protozoan / Q000097:blood / Q000235:genetics*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013030:Spain; D014057:Tomography, X-Ray Computed; D014195:Travel; D014349:Trypanosoma cruzi / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*
D016054:DNA, Protozoan