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Screening for Chagas’ disease in Latin American migrants identifies heart abnormalities, low mortality risk
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A new imaging study presented at the European Association of Cardiovascular Imaging identified the presence of heart abnormalities, despite a lack of symptoms, among Latin American migrants in Spain who have a confirmed diagnosis of Chagas’ disease.
The prevalence of Chagas’ disease among Latin American migrants in Spain has increased in recent years. Although Chagas’ disease is endemic to Latin America, an estimated 50,000 to 70,000 people in Spain have the disease. Many immigrant mothers unknowingly pass the parasite, protozoan Trypanosoma cruzi, to their children during pregnancy. Chagas’ disease not only affects the bowel and the heart, but can cause sudden cardiac death.
Carlos A. Álvarez-Ortega, MD , a cardiology resident at University Hospital La Paz-Carlos III in Madrid, presented new findings on the electrocardiographic and echocardiographic features of Chagas’ disease. Álvarez-Ortega and colleagues conducted a retrospective, observational analysis of 145 patients with Chagas’ disease who were referred to the cardiology unit at the University Hospital La Paz-Carlos III between March 2014 and March 2015. People of Latin American descent voluntarily come for screening for Chagas’ disease and those with a positive blood test for T. cruzi are referred to a cardiologist.
“Most patients are asymptomatic when they come to the clinic,” Álvarez-Ortega said in a press release. “They have heard that Chagas’ disease is deadly and that it is common where they come from. We see entire families, but we mainly screen young women who want to get pregnant and know that prenatal infection is a high risk. In our study we were looking for signs of Chagas’ heart disease before patients had symptoms.”
All patients had a transthoracic echocardiogram (TTE), ECG and physical examination. Country of origin and family history of Chagas’ disease or sudden death were also recorded. Abnormal results from the TTE or ECG were followed up with cardiac magnetic resonance to look for scarring on the heart. Patients also received 24-hour Holter monitoring to record heart rhythm and identify bradycardia.
Sixty-eight percent of the patients were women and 93% were from Bolivia. The average age was 43 years.
On ECG, 34% of the patients had abnormal results and, of those, 31% had bradycardia. Intraventricular conduction delays were another common ECG finding. More than 38% of the patients also had abnormal TTE findings, including a dilated left atrium (34%) and diastolic dysfunction (15%).
The researchers also assessed global mortality risk in the next 4 years using a modified Rassi scale. Overall, 94% of the patients were at low risk for mortality, while 4% were intermediate risk and 2% high risk.
“Our study shows that patients with Chagas’ disease may already have heart abnormalities even if they do not have symptoms,” Álvarez-Ortega said. “Infected patients should get treated early. Once severe heart disease is established the treatment may cause adverse reactions. – by Tracey Romero
Reference:
Álvarez-Ortega CA, et al. Abstract P1327. Presented at: EuroEcho-Imaging Annual Meeting; Dec. 2-5, 2015; Seville, Spain.
Disclosure: The researchers report no relevant financial disclosures.
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