Carod-Artal Francisco Javier, Vargas Antonio Pedro, Horan Thomas Anthony, Nunes Luiz Guillerme Nadal
Department of Neurology, The Sarah Network of Hospitals of Rehabilitation, Sarah Hospital, Brasilia DF, Brazil.
Stroke. 2005 May;36(5):965-70. doi: 10.1161/01.STR.0000163104.92943.50. Epub 2005 Apr 21.
Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. American trypanosomiasis, Chagas disease (CD), is a major public health problem in South America. We sought to evaluate prevalence of vascular risk factors for stroke in patients with stroke caused by CD.
Ninety-four consecutive CD stroke patients and 150 consecutive nonchagasic stroke patients were studied. CD was confirmed when both immunofluorescence and hemagglutination serology were positive. Data collected included age, sex, vascular risk factors, diagnostic stroke subtype (TOAST classification), and echocardiography findings. Fasting plasma levels of protein C, protein S, antithrombin III, homocysteine, activated protein C resistance, IgG anticardiolipin antibodies, lupus anticoagulant, and genetic tests for the factor V Leiden and the C677T methylene tetrahydrofolate reductase gene mutation were determined.
CD patients had a mean age of 56.31 years compared with 61.59 years for non-CD stroke patients (P=0.0002). Cardioembolism occurred in 56.38% of CD stroke patients compared with 9.33% in controls (P=0.000), whereas atherothrombotic strokes occurred in 8.51% of CD strokes versus 20% in controls (P=0.016), and small-vessel stroke in 9.57% of CD stroke patients versus 34.67% in controls (P=0.000). Apical aneurysm (37.23% versus 0.67%; OR, 88.39), left ventricular dilatation (23.4% versus 5.33%; OR, 5.42), mural thrombus (11.7 versus 2%; OR, 6.49) and abnormal electrocardiography (ECG) (66% versus 23.33%; OR, 2.87) were significantly higher in the group of chagasic stroke patients. No statistical differences were observed in thrombophilia between both groups. The significant variables that predicted CD stroke patients on a stepwise logistical regression model were apical aneurysm, cardiac insufficiency, ECG arrhythmia, female gender, and hypertension.
Chagasic cardiomyopathy is independently associated with ischemic stroke, whereas hypercoagulable states do not appear to be major contributors to the excess stroke risk seen in patients with CD.
恰加斯病性心肌病与恰加斯病中的缺血性卒中独立相关。美洲锥虫病，即恰加斯病（CD），是南美洲的一个主要公共卫生问题。我们试图评估由CD引起的卒中患者中卒中血管危险因素的患病率。
对94例连续性CD卒中患者和150例连续性非恰加斯病性卒中患者进行研究。当免疫荧光和血凝血清学均为阳性时确诊为CD。收集的数据包括年龄、性别、血管危险因素、诊断性卒中亚型（TOAST分类）和超声心动图检查结果。测定空腹血浆中蛋白C、蛋白S、抗凝血酶III、同型半胱氨酸、活化蛋白C抵抗、IgG抗心磷脂抗体、狼疮抗凝物水平，以及进行因子V莱顿和C677T亚甲基四氢叶酸还原酶基因突变的基因检测。
CD患者的平均年龄为56.31岁，而非CD卒中患者为61.59岁（P = 0.0002）。CD卒中患者中心源性栓塞发生率为56.38%，而对照组为9.33%（P = 0.000）；CD卒中患者中动脉粥样硬化性血栓形成性卒中发生率为8.51%，而对照组为20%（P = 0.016）；CD卒中患者中小血管卒中发生率为9.57%，而对照组为34.67%（P = 0.000）。恰加斯病性卒中患者组的心尖部动脉瘤（37.23%对0.67%；OR，88.39）、左心室扩张（23.4%对5.33%；OR，5.42）、壁血栓（11.7对2%；OR，6.49）和异常心电图（ECG）（66%对23.33%；OR，2.87）显著更高。两组之间在血栓形成倾向方面未观察到统计学差异。在逐步逻辑回归模型中预测CD卒中患者的显著变量是心尖部动脉瘤、心脏功能不全、ECG心律失常、女性性别和高血压。
恰加斯病性心肌病与缺血性卒中独立相关，而高凝状态似乎不是CD患者中额外卒中风险的主要促成因素。
