Division of Cardiology, Hospital de Clínicas de Porto Alegre and Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Prog Cardiovasc Dis. 2010 Jan-Feb;52(4):300-16. doi: 10.1016/j.pcad.2009.11.008.
A hundred years from its description, Chagas cardiomyopathy remains a challenging disease. Although successful vector-control strategies have decreased the incidence of Chagas disease in several Latin American countries, both migration to urban areas and immigration have spread the disease worldwide; and now, blood transfusion, organ transplantation, and vertical transmission are a concern. The pathogenesis of Chagas cardiomyopathy involves complex host-parasite interactions, where low-grade but incessant systemic infection and triggered autoimmune reaction are the main mechanisms for its development, with the contribution of autonomic damage and microvascular disturbances. Chagas cardiomyopathy is the most important clinical presentation of Chagas disease and comprises a wide range of manifestations, including heart failure, arrhythmias, heart blocks, sudden death, thromboembolism, and stroke. Recently, simple clinical prognostic scores have been developed to identify high-risk patients and help with management. The treatment of Chagas cardiomyopathy focuses mostly on managing heart failure, arrhythmias, and thromboembolism. The role of specific antiparasitic therapy in the chronic form is not yet defined, and a randomized trial is now under way to address this crucial point. In this article, we review the main clinical aspects of Chagas cardiomyopathy and underscore some upcoming challenges for the appropriate control, diagnosis, and management of this complex disease.
从描述到现在已经过去了一百年，Chagas 心肌病仍然是一种具有挑战性的疾病。尽管成功的病媒控制策略已经降低了几个拉丁美洲国家的 Chagas 病发病率，但移民到城市地区和移民已经使该病在全球范围内传播；现在，输血、器官移植和垂直传播令人担忧。Chagas 心肌病的发病机制涉及复杂的宿主-寄生虫相互作用，其中低度但持续不断的全身感染和触发的自身免疫反应是其发展的主要机制，自主损伤和微血管紊乱也有贡献。Chagas 心肌病是 Chagas 病最重要的临床表现，包括心力衰竭、心律失常、心脏传导阻滞、猝死、血栓栓塞和中风。最近，已经开发出简单的临床预后评分来识别高危患者并帮助管理。Chagas 心肌病的治疗主要集中在管理心力衰竭、心律失常和血栓栓塞。在慢性形式中，特定的抗寄生虫治疗的作用尚未确定，目前正在进行一项随机试验来解决这一关键问题。本文综述了 Chagas 心肌病的主要临床方面，并强调了适当控制、诊断和管理这种复杂疾病所面临的一些新挑战。
