Mahmoud I Traina1, Daniel R Sanchez2, Salvador Hernandez2, Jason S Bradfield2, Mohamed R Labedi2, Tarik A Ngab2, Frank Steurer2, Susan P Montgomery2, Sheba K Meymandi2. 1. From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.). mtraina@dhs.lacounty.gov. 2. From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.).
Abstract
BACKGROUND: Chagas disease is a well-known cause of cardiomyopathy in Latin America; however, 300 000 individuals are estimated to have Chagas disease in the United States. This study examined the prevalence and impact of Chagas cardiomyopathy (CCM) in a US population. We hypothesized that patients with CCM would have increased morbidity and mortality when compared with patients with non-CCM. METHODS AND RESULTS: This is a single-center, prospective cohort study. Enrollment criteria were new diagnosis of nonischemic cardiomyopathy (left ventricular ejection fraction ≤40%) and previous residence in Latin America for at least 12 months. Serological testing for Trypanosoma cruzi was performed at enrollment. The primary end point was all-cause mortality or heart transplantation. The secondary end point was heart failure-related hospitalization. A total of 135 patients were enrolled, with a median of 43 months of follow-up. Chagas disease was diagnosed in 25 (19%) patients. The primary end point occurred in 9 patients (36%) in the CCM group and in 11 patients (10%) in the non-CCM group (hazard ratio [HR], 4.46; 95% confidence interval, 1.8-10.8; P=0.001). The secondary end point occurred in 13 patients (52%) in the CCM group and in 35 patients (32%) in the non-CCM group (HR, 2.22; 95% confidence interval, 1.2-4.2; P=0.01). CONCLUSIONS: There is a high prevalence of Chagas disease among Latin American immigrants diagnosed with nonischemic cardiomyopathy in Los Angeles. Advanced CCM portends a poor prognosis and is associated with increased all-cause mortality/heart transplantation and heart failure-related hospitalization.
BACKGROUND:Chagas disease is a well-known cause of cardiomyopathy in Latin America; however, 300 000 individuals are estimated to have Chagas disease in the United States. This study examined the prevalence and impact of Chagas cardiomyopathy (CCM) in a US population. We hypothesized that patients with CCM would have increased morbidity and mortality when compared with patients with non-CCM. METHODS AND RESULTS: This is a single-center, prospective cohort study. Enrollment criteria were new diagnosis of nonischemic cardiomyopathy (left ventricular ejection fraction ≤40%) and previous residence in Latin America for at least 12 months. Serological testing for Trypanosoma cruzi was performed at enrollment. The primary end point was all-cause mortality or heart transplantation. The secondary end point was heart failure-related hospitalization. A total of 135 patients were enrolled, with a median of 43 months of follow-up. Chagas disease was diagnosed in 25 (19%) patients. The primary end point occurred in 9 patients (36%) in the CCM group and in 11 patients (10%) in the non-CCM group (hazard ratio [HR], 4.46; 95% confidence interval, 1.8-10.8; P=0.001). The secondary end point occurred in 13 patients (52%) in the CCM group and in 35 patients (32%) in the non-CCM group (HR, 2.22; 95% confidence interval, 1.2-4.2; P=0.01). CONCLUSIONS: There is a high prevalence of Chagas disease among Latin American immigrants diagnosed with nonischemic cardiomyopathy in Los Angeles. Advanced CCM portends a poor prognosis and is associated with increased all-cause mortality/heart transplantation and heart failure-related hospitalization.
Authors: Romain A Colas; Anthony W Ashton; Shankar Mukherjee; Jesmond Dalli; Oscar B Akide-Ndunge; Huan Huang; Mahalia S Desruisseaux; Fangxia Guan; Linda A Jelicks; Fabiane Matos Dos Santos; Jyothi Nagajyothi; Michael A Zingman; Jinet Reyes; Louis M Weiss; Charles N Serhan; Herbert B Tanowitz Journal: Infect Immun Date: 2018-03-22 Impact factor: 3.441
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