Perfil clínico y afectación cardiológica en pacientes con enfermedad de chagas de área no endémicaimplicaciones para un uso racional de pruebas complementarias

Resumo

Chagas disease (CD) is a chronic parasitic infection being the development of dilated cardiomyopathy its most severe and common complication . Due to changes in migration patterns, CD is a merging problem in EU countries, so there is a need of a better knowledge about the burden of cardiac disease and the optimal diagnostic approach. Aims: To determine the prevalence of the abnormalities found in cardiac imaging techniques To assess the role of the electrocardiogram to predict fibrosis in cRMI and its prognostic value. To determine the diagnostic performance of Selvester score and establish optimal cut-off points to assess different cMRI scar sizes. Methods: We included consecutive patients who underwent screening for CD with electrocardiogram, echocardiogram, and cardiac magnetic resonance (cMRI). Results: A total of 84 patients were included; mean age was 41,7 ± 11,5 years, and 54,8% were female. None of the patients reported symptoms during initial clinical evaluation. Electrocardiograhic abnormalities were present in 40%, being complete right bundle branch block the most common finding. Mean ejection fraction was 61 ± 7 % but echocardiographic abnormalities were found in 25% of the population, mainly due to segmental abnormalities, being the apical wall the most frequently involved. Myocardial fibrosis was detected in up to 30% of patients (mean extension of fibrosis of 4%) . The electrocardiogram was a very useful tool to rule out myocardial fibrosis, with a negative predictive value of 92% for any grade and 100% for the presence of more than 10% of extension. Selvester score showed a strong correlation with the presence of fibrosis in cMRI. Optimal cut-off points were 2 for the presence of any scar, 3 for delayed enhacement (DE) superior to 6% and 5 for DE superior to 10%. After a mean follow-up of 6.2±2.6 years, 6 patients experienced events (1 sudden death, 1 tachycardiomyopathy due to atrial fibrillation, 3 pacemaker implantation, 1 recurrent coronary vasospasm). No patient with normal electrocardiogram had an event during follow-up. Conclusion: Pathological findings are common despite being an asymptomatic young population with preserved ejection fraction. Although different techniques can be used to detect CD, the electrocardiogram is the most useful tool for screening purposes. The absence of electrocardiographic abnormalities confers an excellent prognosis