Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Belo Horizonte, Minas Gerais , Brasil.
Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brasil.
Rev Soc Bras Med Trop. 2022 Jun 6;55:e0575. doi: 10.1590/0037-8682-0575-2021. eCollection 2022.
Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.
尽管在控制方面取得了重大进展，但恰加斯病仍然是拉丁美洲的一个主要公共卫生问题，并已成为全球关注的健康问题。该病影响约 600 万人，其中 20-40%的人在初次感染克氏锥虫后多年会发展为心肌病。恰加斯心肌病是恰加斯病最严重和最常见的表现。临床表现根据心肌功能障碍的严重程度差异很大，从无症状到严重形式不等，包括心力衰竭、心律失常、血栓栓塞事件和猝死的扩张型心肌病。无论心肌病的严重程度如何，恰加斯病都是中风的一个危险因素，是慢性残疾的主要原因。传统上，认为恰加斯病患者中风的病因是心源性栓塞，与心尖部动脉瘤、壁血栓和心房心律失常有关。尽管大多数中风是血栓栓塞性的，但也观察到了其他病因。在恰加斯病和中风患者中，已报道了小血管疾病、动脉粥样硬化和隐源性疾病。与非栓塞性中风相关的潜在机制包括存在相关危险因素、促炎和促血栓形成疾病状态以及内皮功能障碍。然而，每种机制对恰加斯病中风的贡献仍不清楚。本综述旨在概述恰加斯病中的中风，重点介绍主要的病理生理机制、临床表现、预防方法以及治疗策略方面的未解决问题。
