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. 2009 Feb 3;23(12):883–889. doi: 10.1002/clc.4960231205

Chagas' Heart Disease

Anis Rassi Jr 1,✉, Anis Rassi 1, William C Little 2
PMCID: PMC6655136  PMID: 11129673

Abstract

Chagas' disease is caused by a protozoan parasite, Trypanosoma cruzi, that is transmitted to humans through the feces of infected bloodsucking insects in endemic areas of Latin America, or occasionally by nonvectorial mechanisms, such as blood transfusion. Cardiac involvement, which typically appears decades after the initial infection, may result in cardiac arrhythmias, ventricular aneurysm, congestive heart failure, thromboembolism, and sudden cardiac death. Between 16 and 18 million persons are infected in Latin America. The migration of infected Latin Americans to the United States or other countries where the disease is uncommon poses two problems: the misdiagnosis or undiagnosis of Chagas' heart disease in these immigrants and the possibility of transmission of Chagas' disease through blood transfusions. Diagnosis is based on positive serologic tests and the clinical features. The antiparasitic drug, benznidazole, is effective when given for the initial infection and may also be beneficial for the chronic phase. The use of amiodarone, angiotensin‐converting enzyme inhibitors, and pacemaker implantation may contribute to a better survival in selected patients with cardiac involvement of chronic Chagas' disease.

Keywords: Chagas' heart disease, Chagas' disease, chronic chagasic cardiopathy, review

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References

  • 1. Chagas C: Nova Tripanozomiaze humana. Estudos sobre a morfolojia e o ciclo evolutivo do Schizotrypanum cruzi n. gen., n. sp., ajente etiolojico de nova entidade morbida do homem. Mem Inst Oswaldo Cruz 1909; 1: 1–80 [Google Scholar]
  • 2. WHO : Control of Chagas disease. WHO Technical Report Series 1991; 811: 1–95 [PubMed] [Google Scholar]
  • 3. Kirchoff LV: Chagas disease and blood transfusion in non‐endemic areas In Chagas Disease (American Trypanosomiasis): Its Impact on Transfusion and Clinical Medicine (Eds. Wendel S, Brener Z, Camargo ME, Rassi A.), p. 143–152. São Paulo: ISBT Brazil, 1992. [Google Scholar]
  • 4. Laranja FS, Dias E, Nobrega G, Miranda A: Chagas' disease: A clinical, epidemiologic, and pathologic study. Circulation 1956; 14: 1035–1060 [DOI] [PubMed] [Google Scholar]
  • 5. Rassi A, Luquetti AO: Therapy of Chagas disease In Chagas Disease (American Trypanosomiasis): Its Impact on Transfusion and Clinical Medicine (Eds. Wendel S, Brener Z, Camargo ME, Rassi A.), p. 237–247. São Paulo: ISBT Brazil, 1992. [Google Scholar]
  • 6. Dias JCP: Natural history of Chagas' disease. Arq Bras Cardiol 1995; 65: 359–366 [PubMed] [Google Scholar]
  • 7. Takle GB, Hudson L: Autoimmunity and Chagas' disease. Curr Top Microbiol Immunol 1989; 145: 79–92 [PubMed] [Google Scholar]
  • 8. Rizzo LV, Cunha‐Neto E, Teixeira AR: Autoimmunity in Chagas' disease: Specific inhibition of reactivity of CD4+ T cells against myosin in mice chronically infected with Trypanosoma cruzi. Infect Immun 1989; 57: 2640–2644 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Cunha‐Neto E, Rizzo LV, Albuquerque F, Abel L, Guilherme L, Bocchi E, Bacal F, Carrara D, Ianni B, Mady C, Kalil J: Cytokine production profile of heart‐infiltrating T cells in Chagas' disease cardiomyopathy. Braz J Med Biol Res 1998; 31: 133–137 [DOI] [PubMed] [Google Scholar]
  • 10. Andrade ZA, Andrade SG, Correa R, Sadigursky M, Ferrans VJ: Myocardial changes in acute Trypanosoma cruzi infection. Ultrastructural evidence of immune damage and the role of microangiopathy. Am J Pathol 1994; 144: 1403–1411 [PMC free article] [PubMed] [Google Scholar]
  • 11. Cossio PM, Diez C, Szarfman A, Kreutzer E, Candiolo B, Arana RM: Chagasic cardiopathy. Demonstration of a serum gamma globulin factor which reacts with endocardium and vascular structures. Circulation 1974; 49: 13–21 [DOI] [PubMed] [Google Scholar]
  • 12. Szarfman A, Luquetti A, Rassi A, Rezende JM, Schmuñis GA: Tissue‐reacting immunoglobulins in patients with different clinical forms of Chagas' disease. Am J Trop Med Hyg 1981; 30: 43–46 [DOI] [PubMed] [Google Scholar]
  • 13. Higuchi ML, De Brito T, Reis MM, Barbosa A, Bellotti G, Pereira‐Barreto AC, Pileggi F: Correlation between Trypanosoma cruzi parasitism and myocardial inflammatory infiltrate in human chronic chagasic myocarditis: Light microscopy and immunohistochemical findings. Cardiovasc Pathol 1993; 2: 101–106 [DOI] [PubMed] [Google Scholar]
  • 14. Jones EM, Colley DG, Tostes S, Lopes ER, Vnencak‐Jones CL, McCurley TL: Amplification of a Trypanosoma cruzi DNA sequence from inflammatory lesions in human chagasic cardiomyopathy. Am J Trop Med Hyg 1993; 48: 348–357 [DOI] [PubMed] [Google Scholar]
  • 15. Bellotti G, Bocchi EA, De Moraes AV, Higuchi ML, Barbero‐Marcial M, Sosa E, Esteves‐Filho A, Kalil R, Weiss R, Jatene A, Pileggi F: In vivo detection of Trypanosoma cruzi antigens in hearts of patients with chronic Chagas' heart disease. Am Heart J 1996; 131: 301–307 [DOI] [PubMed] [Google Scholar]
  • 16. Rossi MA: Microvascular changes as a cause of chronic cardiomyopathy in Chagas' disease. Am Heart J 1990; 120: 233–236 [DOI] [PubMed] [Google Scholar]
  • 17. Koberle F: Patogenia da moléstia de Chagas. Estudo dos órgãos musculares ǒcos. Rev Goiana Med 1957; 3: 155–180 [Google Scholar]
  • 18. Marin‐Neto JA: Cardiac dysautonomia and pathogenesis of Chagas' heart disease. Int J Cardiol 1998; 66: 129–131 [DOI] [PubMed] [Google Scholar]
  • 19. Rossi MA: The pattern of myocardial fibrosis in chronic Chagas' heart disease. Int J Cardiol 1991, 30: 335–340 [DOI] [PubMed] [Google Scholar]
  • 20. Oliveira JSM: A natural human model of intrinsic heart nervous system denervation: Chagas' cardiopathy. Am Heart J 1985; 110: 1092–1098 [DOI] [PubMed] [Google Scholar]
  • 21. Oliveira JSM, Mello‐de‐Oliveira JA, Frederigue U Jr, Lima‐Filho EC: Apical aneurysm of Chagas' heart disease. Br Heart J 1981; 46: 432–437 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Oliveira JSM, Araujo RRC, Navarro MA, Muccillo G: Cardiac thrombosis and thromboembolism in chronic Chagas' heart disease. Am J Cardiol 1983; 52: 147–151 [DOI] [PubMed] [Google Scholar]
  • 23. Chiale PA, Halpern S, Nau GJ, Przybylski J, Tambussi AM, Lázzari JO, Elizari MV, Rosenbaum MB: Malignant ventricular arrhythmias in chronic chagasic myocarditis. PACE 1982; 5: 162–172 [DOI] [PubMed] [Google Scholar]
  • 24. Rassi A Jr, Rassi AG, Rassi SG, Rassi L Jr, Rassi A: Ventricular arrhythmias in Chagas' disease. Diagnostic, prognostic, and therapeutic aspects. Arq Bras Cardiol 1995; 65: 377–387 [PubMed] [Google Scholar]
  • 25. Mendoza I, Camardo J, Moleiro F, Castellanos A, Medina V, Gomez J, Acquatella H, Casal H, Tortoledo F, Puigbo J: Sustained ventricular tachycardia in chronic myocarditis: Electrophysiologic and pharmacologic characteristics. Am J Cardiol 1986; 57: 423–427 [DOI] [PubMed] [Google Scholar]
  • 26. Giniger AG, Retyk EO, Laiño RA, Sananes EG, Lapuente AR: Ventricular tachycardia in Chagas' disease. Am J Cardiol 1992; 70: 459–462 [DOI] [PubMed] [Google Scholar]
  • 27. Sosa E, Scanavacca M, D'Avila A, Piccioni J, Sanchez O, Velarde JL, Silva M, Reolão B: Endocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia. J Cardiovasc Electrophysiol 1998; 9: 229–239 [DOI] [PubMed] [Google Scholar]
  • 28. Acquatella H, Schiller NB, Puigbó JJ, Giordano H, Suárez JA, Casal H, Arreaza N, Valecillos R, Hirschhaut E: M‐mode and two‐dimensional echocardiography in chronic Chagas' heart disease. A clinical and pathologic study. Circulation 1980; 62: 787–799 [DOI] [PubMed] [Google Scholar]
  • 29. Rassi A Jr, Rassi SG, Rassi AG, Rassi A: Sudden death in Chagas' disease: Review. Arq Bras Cardiol 2001; 76 (1) (in press) [DOI] [PubMed] [Google Scholar]
  • 30. Combellas I, Puigbo JJ, Acquatella H, Tortoledo F, Gomez JR: Echocardiographic features of impaired left ventricular diastolic function in Chagas's heart disease. Br Heart J 1985; 53: 298–309 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Rassi A Jr, Waktare JEP, Rassi SG, Rassi AG, Rassi L Jr, Miglino R, Hnatkova K, Malik M, Rassi A: Chagas heart disease: Long term prognostic significance of nonsustained ventricular tachycardia and left ventricular dysfunction (abstr). PACE 1999; 22 (Part 1I): 862 [Google Scholar]
  • 32. De Paola AAV, Gomes JA, Terzian AB, Miyamoto MH, Martinez EE: Ventricular tachycardia during exercise testing as a predictor of sudden death in patients with chronic chagasic cardiomyopathy and ventricular arrhythmias. Br Heart J 1995; 74: 293–295 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Segura MA, Molina‐de‐Raspi E, Basombrio MA: Reversibility of muscle and heart lesions in chronic Trypanosoma cruzi infected mice after late trypanomicidal treatment. Mem Inst Oswaldo Cruz 1994; 89: 213–216 [DOI] [PubMed] [Google Scholar]
  • 34. De Andrade AL, Zicker F, de Oliveira RM, Almeida‐Silva S, Luquetti A, Travassos LR, Almeida IC, de Andrade SS, de Andrade JG, Martelli CM: Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection. Lancet 1996; 348: 1407–1413 [DOI] [PubMed] [Google Scholar]
  • 35. Estani SS, Segura EL, Ruiz AM, Velazquez E, Porcel BM, Yampotis C: Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas' disease. Am J Trap Med Hyg 1998; 59: 526–529 [DOI] [PubMed] [Google Scholar]
  • 36. Viotti R, Vigliano C, Armenti H, Segura E: Treatment of chronic Chagas' heart disease with benznidazole: Clinical and serologic evolution of patients with long‐term follow‐up. Am Heart J 1994; 127: 151–162 [DOI] [PubMed] [Google Scholar]
  • 37. Chiale PA, Halpern MS, Nau GJ, Tambussi AM, Przybylski J, Lázzari JO, Elizari MV, Rosenbaum MB: Efficacy of amiodarone during long term treatment of malignant ventricular arrhythmias in patients with chronic chagasic myocarditis. Am Heart J 1984; 107: 656–665 [DOI] [PubMed] [Google Scholar]
  • 38. ATMA Investigators : Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: Meta‐analysis of individual data from 6,500 patients in randomised trials. Lancet 1997; 350: 1417–142 [PubMed] [Google Scholar]
  • 39. Milei J, Pesce R, Valero E, Muratore C, Beigelman R, Ferrans VJ: Electrophysiologic‐structural correlations in chagasic aneurysms causing malignant arrhythmias. Int J Cardiol 1991; 32: 65–73 [DOI] [PubMed] [Google Scholar]
  • 40. Sosa E, Marcial MB, Pileggi F: Taquicardia ventricular. Tratamento cirúrgico dirigido. Experiěncia inicial. Arq Bras Cardiol 1982; 38: 449–454 [PubMed] [Google Scholar]
  • 41. De Paola AA, Gomes JA, Miyamoto MH, Fo EE: Transcoronary chemical ablation of ventricular tachycardia in chronic chagasic myocarditis. J Am Coll Cardiol 1992; 20: 480–482 [DOI] [PubMed] [Google Scholar]
  • 42. Sosa E, Scalabrini A, Rati M, Bellotti G, Pileggi F: Successful catheter ablation of the “origin” of recurrent ventricular tachycardia in chronic chagasic heart disease. J Electrophysiol 1987; 1: 58–61 [Google Scholar]
  • 43. Sosa E, Scanavacca M, D'Avila A, Bellotti G, Pilleggi F: Radio‐frequency catheter ablation of ventricular tachycardia guided by nonsurgical epicardial mapping in chronic chagasic heart disease. PACE 1999; 22: 128–130 [DOI] [PubMed] [Google Scholar]
  • 44. The SOLVD Investigators : Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection. N Engl J Med 1992; 327: 685–691 [DOI] [PubMed] [Google Scholar]
  • 45. CIBIS‐II Investigators and Committees : The cardiac insufficiency bisoprolol study II (CIBIS‐II): A randomised trial. Lancet 1999; 353: 9–13 [PubMed] [Google Scholar]
  • 46. MERIT‐HF Study Group : Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT‐HF). Lancet 1999; 353: 2001–2007 [PubMed] [Google Scholar]
  • 47. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J, for the Randomized Aldactone Evaluation Study Investigators : The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999; 341: 709–717 [DOI] [PubMed] [Google Scholar]
  • 48. De Carvalho VB, Sousa EF, Vila JH, da Silva JP, Caiado MR, Araujo SR, Macruz R, Zerbini EJ: Heart transplantation in Chagas' disease. 10 years after initial experience. Circulation 1996; 94: 1815–1817 [DOI] [PubMed] [Google Scholar]
  • 49. Bocchi EA, Bellotti G, Mocelin AO, Uip D, Bacal F, Higuchi ML, Amato‐Neto V, Fiorelli A, Stolf NA, Jatene AD, Pileggi F: Heart transplantation for chronic Chagas' heart disease. Ann Thorac Surg 1996; 61: 1727–1733 [DOI] [PubMed] [Google Scholar]
  • 50. Rassi A, Amato‐Neto V, de Siqueira AF, Leite MS: Nifurtimox as a prophylactic drug to prevent reactivation in chronic chagasic patients treated with corticoid for associated diseases. Rev Soc Bras Med Trop 1998; 31: 249–255 [DOI] [PubMed] [Google Scholar]
  • 51. Moreira LF, Stolf NA, Braile DM, Jatene AD: Dynamic cardiomyoplasty in South America. Ann Thorac Surg 1996; 61: 408–412 [DOI] [PubMed] [Google Scholar]
  • 52. Batista RJ, Verde J, Nery P, Bocchino L, Takeshita N, Bhayana JN, Bergsland J, Graham S, Houck JP, Salerno TA: Partial left ventriculectomy to treat end‐stage heart disease. Ann Thorac Surg 1997; 64: 634–638 [DOI] [PubMed] [Google Scholar]
  • 53. Stolf NA, Moreira LF, Bocchi EA, Higuchi ML, Bacal F, Bellotti G, Jatene AD: Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy. Ann Thorac Surg 1998; 66: 1585–1591 [DOI] [PubMed] [Google Scholar]
  • 54. Navin TR, Roberto RR, Juranek DD, Limpakarnjanarat K, Mortenson EW, Clover JR, Yescott RE, Taclindo C, Steurer F, Allain D: Human and sylvatic Trypanosoma cruzi infection in California. Am J Public Health 1985; 75: 366–369 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55. Milei J, Mautner B, Storino R, Sanchez JA, Ferrans VJ: Does Chagas' disease exist as an undiagnosed form of cardiomyopathy in the United States? Am Heart J 1992; 123: 1732–1735 [DOI] [PubMed] [Google Scholar]
  • 56. Hagar JM, Rahimtoola SH: Chagas' heart disease in the United States. N Engl J Med 1991; 325: 763–768 [DOI] [PubMed] [Google Scholar]
  • 57. Wendel S, Gonzaga AL: Chagas' disease and blood transfusion: A new world problem? Vox Sang 1993; 64: 1–12 [DOI] [PubMed] [Google Scholar]

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