Hagar J M, Rahimtoola S H
Department of Medicine, University of Southern California Medical Center, Los Angeles.
N Engl J Med. 1991 Sep 12;325(11):763-8. doi: 10.1056/NEJM199109123251103.
Chagas' heart disease is believed to be rare in the United States, although many persons from countries where the disease is endemic reside here. We performed a retrospective case review and prospective follow-up of 25 patients with Chagas' heart disease and no obstructive coronary artery disease on angiography.
The patients mainly presented with symptomatic atrioventricular block, congestive heart failure, anginal chest pain, sudden death averted by resuscitation, or sustained ventricular tachycardia. Of the 25 patients, 18 had been treated for coronary artery disease or idiopathic dilated cardiomyopathy for up to 108 months before the diagnosis of Chagas' disease was considered. The electrocardiograms frequently suggested coronary artery disease. Six of the seven patients who had exercise thallium-perfusion scans had abnormalities suggesting ischemia or infarction. A left ventricular aneurysm was found in 14 of the 25 patients, segmental akinesia or hypokinesia in 5, and diffuse hypokinesia in 3. Programmed ventricular stimulation performed in 13 patients induced sustained ventricular tachycardia in 9 and nonsustained ventricular tachycardia in 2. Actuarial survival (mean +/- SE) after four years for the entire group was 56 +/- 12 percent; it was 32 +/- 16 percent among those with global left ventricular dysfunction, and 78 +/- 14 percent among those without such dysfunction (P = 0.03). Only patients with left ventricular dysfunction or an aneurysm died (four-year survival, 45 +/- 14 percent, as compared with 100 percent for the remaining patients; P = 0.0002). Heart failure and left ventricular aneurysm or dysfunction were the only independent predictors of death. Nine patients required permanent pacemakers.
In the United States, Chagas' heart disease commonly mimics coronary artery disease or idiopathic dilated cardiomyopathy. The prognosis is poor for patients with heart failure or left ventricular aneurysm or dysfunction. The disease may be underdiagnosed in the United States.
尽管许多来自恰加斯病（Chagas' disease）流行国家的人居住在美国，但人们认为恰加斯心脏病在美国较为罕见。我们对25例经血管造影证实无阻塞性冠状动脉疾病的恰加斯心脏病患者进行了回顾性病例分析和前瞻性随访。
患者主要表现为有症状的房室传导阻滞、充血性心力衰竭、心绞痛性胸痛、经复苏避免的猝死或持续性室性心动过速。在这25例患者中，18例在考虑诊断为恰加斯病之前，因冠状动脉疾病或特发性扩张型心肌病接受了长达108个月的治疗。心电图常提示冠状动脉疾病。7例进行运动铊灌注扫描的患者中有6例存在提示缺血或梗死的异常表现。25例患者中有14例发现左心室室壁瘤，5例有节段性运动减弱或运动减退，3例有弥漫性运动减退。13例患者进行了程控心室刺激，其中9例诱发了持续性室性心动过速，2例诱发了非持续性室性心动过速。整个组4年后的精算生存率（均值±标准误）为56±12%；左心室整体功能障碍患者为32±16%，无此功能障碍患者为78±14%（P = 0.03）。仅左心室功能障碍或有室壁瘤的患者死亡（4年生存率为45±14%，其余患者为100%；P = 0.0002）。心力衰竭以及左心室室壁瘤或功能障碍是死亡的唯一独立预测因素。9例患者需要植入永久性起搏器。
在美国，恰加斯心脏病常被误诊为冠状动脉疾病或特发性扩张型心肌病。心力衰竭或左心室室壁瘤或功能障碍患者的预后较差。在美国，该病可能未得到充分诊断。
