Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Int J Cardiol. 2025 Jan 1;418:132628. doi: 10.1016/j.ijcard.2024.132628. Epub 2024 Oct 10.
Chagas disease is a risk factor for ischemic stroke, which causes high mortality rates and significant disability. This study aims to determine the incidence and risk factors for ischemic strokes in a large cohort of Chagas cardiomyopathy patients, with a particular focus on the mechanisms involved in the pathophysiology of stroke in this condition.
The study enrolled 517 patients with Chagas cardiomyopathy who were referred to our institution from March 2000 to December 2021. All patients underwent systematic cardiological and neurological assessments. The primary outcome was the occurrence of ischemic stroke during the follow-up period, classified based on the SSS-TOAST and CCS criteria. Natural cubic splines functions were applied to examine the potential nonlinear association between continuous variables and stroke risk.
The mean age of the cohort was 52 ± 13 years, and 299 (58 %) were men. During a mean follow-up period of 4.8 years (interquartile range-IQR 1.1 to 7.1 years), a total of 72 patients (14.8 %) had an ischemic stroke, being fatal in 10. The overall incidence rate of ischemic stroke was 3.0/100 patient-years (95 % confidence interval 2.4 to 3.8). The stroke subtypes were cardioembolic (n = 41), undetermined (n = 11), and other subtypes (n = 20). The predictors of stroke were age, left atrial volume, left ventricular ejection fraction (LVEF), LV thrombus and prior stroke with thrombus. There was a nonlinear relationship between stroke risk, LVEF, and left atrial volume. A bimodal distribution of stroke occurrences was observed according to the severity of LV dysfunction, with a threshold for LVEF of 45 %. The final model for stroke risk prediction showed good discrimination, with a C statistic of 0.775.
In a contemporary cohort of Chagas disease patients with a broad spectrum of disease severity, stroke incidence remains high despite anticoagulation. Stroke risk shows a nonlinear association with ventricular dysfunction and left atrial size, highlighting a distinct bimodal pattern of stroke occurrence in Chagas disease.
恰加斯病是缺血性中风的一个危险因素，这种中风会导致高死亡率和显著的残疾。本研究旨在确定在一大群恰加斯心肌病患者中，缺血性中风的发生率和危险因素，特别关注这种情况下中风病理生理学中涉及的机制。
该研究纳入了 2000 年 3 月至 2021 年 12 月期间因恰加斯心肌病而被我院收治的 517 名患者。所有患者均接受了系统的心脏和神经评估。主要结局是在随访期间发生缺血性中风，根据 SSS-TOAST 和 CCS 标准进行分类。应用自然三次样条函数来检查连续变量与中风风险之间的潜在非线性关系。
队列的平均年龄为 52 ± 13 岁，299 名（58%）为男性。在平均 4.8 年（四分位距-IQR 1.1 至 7.1 年）的随访期间，共有 72 名患者（14.8%）发生缺血性中风，其中 10 人死亡。缺血性中风的总发生率为 3.0/100 患者年（95%置信区间 2.4 至 3.8）。中风亚型为心源性栓塞（n=41）、不明原因（n=11）和其他亚型（n=20）。中风的预测因素是年龄、左心房容积、左心室射血分数（LVEF）、左心室血栓和既往有血栓的中风。中风风险与 LVEF 和左心房容积之间存在非线性关系。根据左心室功能障碍的严重程度，观察到中风发生的双峰分布，LVEF 的阈值为 45%。中风风险预测的最终模型显示出良好的区分能力，C 统计量为 0.775。
在一组恰加斯病患者中，尽管进行了抗凝治疗，但在广泛的疾病严重程度范围内，中风的发生率仍然很高。中风风险与心室功能障碍和左心房大小呈非线性关系，突出了恰加斯病中中风发生的双峰模式。
