冠状动脉计算机断层血管造影显示慢性恰加斯病患者冠状动脉粥样硬化发生率和严重程度较低。
Lower Prevalence and Severity of Coronary Atherosclerosis in Chronic Chagas' Disease by Coronary Computed Tomography Angiography.
机构信息
Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP - Brasil.
Duke University Hospital - Medicine/Cardiology, North Carolina - EUA.
出版信息
Arq Bras Cardiol. 2020 Dec;115(6):1051-1060. doi: 10.36660/abc.20200342.
BACKGROUND
In Chagas' disease endemic regions, there has been for many years a recurrent empirical observation that coronary artery disease (CAD) is uncommon in patients with Chagas' disease. Previous pathological and invasive coronary angiography studies led to controversial results.
OBJECTIVE
We sought to investigate whether CAD is less prevalent and less severe in patients with chronic Chagas' disease when compared with a matched population with a similar CAD risk profile.
METHODS
A total of 86 participants, 43 consecutive patients with chronic Chagas' disease and 43 asymptomatic individuals, without any prior history of cardiac disease or known CAD (control group), were included. Patients and controls were matched according to gender, age, and Framingham risk score. All participants underwent coronary calcium scoring and coronary computed tomography angiography on a 320-row detector scanner. Statistical significance level adopted was p < 0.05.
RESULTS
The coronary artery calcium score (CACS) was significantly lower in patients with Chagas' disease than in controls (p<0.05). The presence of coronary atherosclerotic plaques was significantly less frequent in patients with Chagas' disease than in controls (20.9% versus 41.9%, p=0.037). After adjustment for the Framingham score, the odds ratio for the presence of any coronary artery calcium (CAC) in Chagas patients was 0.26 (95%CI: 0.07-0.99, p=0.048). The pattern is similar for CACS > 10 (OR: 0.11, 95%CI: 0.01-0.87, p=0.04) and for the presence of any stenosis (OR: 0.06, 95%CI: 0.01-0.47, p=0.001). Propensity score matching also indicated an effect of Chagas disease on the CACS (-21.6 points in the absolute score and 25% less of patients with CACS >10, p=0.015).
CONCLUSIONS
CAD is less prevalent and less severe in patients with chronic Chagas' disease when compared with a matched population with a similar CAD risk profile. (Arq Bras Cardiol. 2020; 115(6):1051-1060).
背景
在恰加斯病流行地区，多年来一直存在一个反复出现的经验观察结果，即恰加斯病患者的冠状动脉疾病（CAD）不常见。先前的病理学和有创性冠状动脉造影研究得出了有争议的结果。
目的
我们旨在研究慢性恰加斯病患者的 CAD 是否比具有相似 CAD 风险特征的匹配人群更不常见且更不严重。
方法
共纳入 86 名参与者，其中 43 名连续慢性恰加斯病患者和 43 名无症状个体（对照组），无任何先前的心脏病史或已知 CAD。患者和对照组根据性别、年龄和弗雷明汉风险评分进行匹配。所有参与者均在 320 排探测器扫描仪上接受冠状动脉钙评分和冠状动脉计算机断层血管造影。采用的统计学显著性水平为 p < 0.05。
结果
恰加斯病患者的冠状动脉钙评分（CACS）明显低于对照组（p<0.05）。恰加斯病患者的冠状动脉粥样硬化斑块发生率明显低于对照组（20.9%比 41.9%，p=0.037）。在校正弗雷明汉评分后，恰加斯病患者任何冠状动脉钙（CAC）存在的优势比为 0.26（95%CI：0.07-0.99，p=0.048）。对于 CACS>10（OR：0.11，95%CI：0.01-0.87，p=0.04）和任何狭窄（OR：0.06，95%CI：0.01-0.47，p=0.001）的模式相似。倾向评分匹配也表明恰加斯病对 CACS 有影响（绝对评分减少 21.6 分，CACS>10 的患者比例减少 25%，p=0.015）。
结论
与具有相似 CAD 风险特征的匹配人群相比，慢性恰加斯病患者的 CAD 发生率较低且程度较轻。（Arq Bras Cardiol. 2020; 115(6):1051-1060）。
Zotero 插件