de Oliveira Maykon Tavares, Schmidt André, da Silva Maria Cláudia, Donadi Eduardo Antônio, da Silva João Santana, Marin-Neto José Antônio
Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Front Cardiovasc Med. 2021 Sep 16;8:741347. doi: 10.3389/fcvm.2021.741347. eCollection 2021.
Chronic Chagas disease (CChD), one of the infectious parasitic diseases with the greatest social and economic impact upon a large part of the American continent, has distinct clinical manifestations in humans (cardiac, digestive, or mixed clinical forms). The mechanisms underlying the development of the most common and ominous clinical form, the chronic Chagas cardiomyopathy (CCC) have not been completely elucidated, despite the fact that a high intensity of parasite persistence in the myocardium is deemed responsible for an untoward evolution of the disease. The present study aimed to assess the parasite load CCC and its relation to left ventricular ejection fraction (LVEF), a definite prognostic marker in patients with CCC. Patients with CCC were clinically evaluated using 12-lead-electrocardiogram, echocardiogram, chest X-ray. Peripheral blood sampling (5 ml of venous blood in guanidine/EDTA) was collected from each patient for subsequent DNA extraction and the quantification of the parasite load using real-time PCR. One-hundred and eighty-one patients with CCC were evaluated. A total of 140 (77.3%) had preserved left ventricular ejection fraction (of ≥40%), and 41 individuals had LV dysfunction (LVEF of <40%). A wide variation in parasite load was observed with a, mean of 1.3460 ± 2.0593 (0.01 to 12.3830) par. Eq./mL. The mean ± SD of the parasite load was 0.6768 ± 0.9874 par. Eq./mL and 3.6312 ± 2.9414 par. Eq./mL in the patients with LVEF ≥ 40% and <40%, respectively. The blood parasite load is highly variable and seems to be directly related to the reduction of LVEF, an important prognostic factor in CCC patients.
慢性恰加斯病（CChD）是对美洲大陆大部分地区具有最大社会和经济影响的传染性寄生虫病之一，在人类中有不同的临床表现（心脏型、消化型或混合型临床形式）。尽管人们认为心肌中高强度的寄生虫持续存在是导致该疾病不良进展的原因，但最常见且最凶险的临床形式——慢性恰加斯心肌病（CCC）的发病机制尚未完全阐明。本研究旨在评估CCC患者的寄生虫载量及其与左心室射血分数（LVEF）的关系，LVEF是CCC患者的一个明确的预后指标。使用12导联心电图、超声心动图、胸部X线对CCC患者进行临床评估。从每位患者采集外周血样本（5毫升胍盐/乙二胺四乙酸抗凝静脉血）用于后续DNA提取，并使用实时聚合酶链反应对寄生虫载量进行定量。对181例CCC患者进行了评估。共有140例（77.3%）患者左心室射血分数保留（≥40%），41例患者存在左心室功能障碍（左心室射血分数<40%）。观察到寄生虫载量有很大差异，平均值为1.3460±2.0593（0.01至12.3830）寄生虫当量/毫升。左心室射血分数≥40%和<40%的患者中，寄生虫载量的平均值±标准差分别为0.6768±0.9874寄生虫当量/毫升和3.6312±2.9414寄生虫当量/毫升。血液中的寄生虫载量高度可变，似乎与左心室射血分数降低直接相关，左心室射血分数是CCC患者的一个重要预后因素。
