Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Treatment and prognosis of Chagas heart disease

INTRODUCTION

Chagas disease (CD) is caused by Trypanosoma cruzi, a protozoan parasite that can cause acute myopericarditis as well as chronic fibrosing myocarditis. Chagas myocarditis is the most common cause of non-ischemic cardiomyopathy in Latin America [1].

The treatment and prognosis of Chagas heart disease will be reviewed here. Other issues related to CD, including clinical manifestations and diagnosis of Chagas heart disease and noncardiac manifestations, are discussed separately. (See "Clinical manifestations and diagnosis of Chagas heart disease" and "Chagas disease: Natural history and diagnosis" and "Pathology and pathogenesis of Chagas disease" and "Gastrointestinal Chagas disease" and "Antitrypanosomal drug therapy for Chagas disease" and "Chagas disease: Management of acute disease, early chronic disease, and disease in immunocompromised hosts".)

PROGNOSIS

Overview — The natural history of Chagas disease has been divided into acute and chronic phases. Cardiac involvement and prognosis in the acute phase of T. cruzi is discussed separately. (See "Clinical manifestations and diagnosis of Chagas heart disease" and "Chagas disease: Natural history and diagnosis".)

The indeterminate form of chronic T. cruzi has been defined as a phase of chronic T. cruzi infection in which anti-T. cruzi antibodies are present but no signs or symptoms of Chagas cardiomyopathy or gastrointestinal involvement are identified. Various criteria have been proposed to define the indeterminate form, as discussed separately. (See "Clinical manifestations and diagnosis of Chagas heart disease", section on 'Definition'.)

About one-third to one-half of patients with the indeterminate form develops cardiomyopathy after a latent period ranging from 5 to 30 years. Chronic Chagas disease cardiomyopathy (CCC) is a cause of heart failure, cardiac arrhythmias and thromboembolism.

                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Jun 27, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Moncayo A, Silveira AC. Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy. Mem Inst Oswaldo Cruz 2009; 104 Suppl 1:17.
  2. Rassi A Jr, Rassi SG, Rassi A. Sudden death in Chagas' disease. Arq Bras Cardiol 2001; 76:75.
  3. Freitas HF, Chizzola PR, Paes AT, et al. Risk stratification in a Brazilian hospital-based cohort of 1220 outpatients with heart failure: role of Chagas' heart disease. Int J Cardiol 2005; 102:239.
  4. Issa VS, Amaral AF, Cruz FD, et al. Beta-blocker therapy and mortality of patients with Chagas cardiomyopathy: a subanalysis of the REMADHE prospective trial. Circ Heart Fail 2010; 3:82.
  5. Espinosa R, Carrasco HA, Belandria F, et al. Life expectancy analysis in patients with Chagas' disease: prognosis after one decade (1973-1983). Int J Cardiol 1985; 8:45.
  6. Rassi A Jr, Rassi A, Little WC, et al. Development and validation of a risk score for predicting death in Chagas' heart disease. N Engl J Med 2006; 355:799.
  7. Rassi A Jr, Rassi A, Rassi SG. Predictors of mortality in chronic Chagas disease: a systematic review of observational studies. Circulation 2007; 115:1101.
  8. Viotti R, Vigliano C, Lococo B, et al. Long-term cardiac outcomes of treating chronic Chagas disease with benznidazole versus no treatment: a nonrandomized trial. Ann Intern Med 2006; 144:724.
  9. Marin-Neto JA, Rassi A Jr, Morillo CA, et al. Rationale and design of a randomized placebo-controlled trial assessing the effects of etiologic treatment in Chagas' cardiomyopathy: the BENznidazole Evaluation For Interrupting Trypanosomiasis (BENEFIT). Am Heart J 2008; 156:37.
  10. Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet 2010; 375:1388.
  11. Botoni FA, Poole-Wilson PA, Ribeiro AL, et al. A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy. Am Heart J 2007; 153:544.e1.
  12. Bocchi EA, Bellotti G, Mocelin AO, et al. Heart transplantation for chronic Chagas' heart disease. Ann Thorac Surg 1996; 61:1727.
  13. Bocchi EA, Fiorelli A. The paradox of survival results after heart transplantation for cardiomyopathy caused by Trypanosoma cruzi. First Guidelines Group for Heart Transplantation of the Brazilian Society of Cardiology. Ann Thorac Surg 2001; 71:1833.
  14. Moreira LF, Stolf NA, Braile DM, Jatene AD. Dynamic cardiomyoplasty in South America. Ann Thorac Surg 1996; 61:408.
  15. Ribeiro Dos Santos R, Rassi S, Feitosa G, et al. Cell therapy in Chagas cardiomyopathy (Chagas arm of the multicenter randomized trial of cell therapy in cardiopathies study): a multicenter randomized trial. Circulation 2012; 125:2454.
  16. Cardinalli-Neto A, Bestetti RB, Cordeiro JA, Rodrigues VC. Predictors of all-cause mortality for patients with chronic Chagas' heart disease receiving implantable cardioverter defibrillator therapy. J Cardiovasc Electrophysiol 2007; 18:1236.
  17. Rassi A Jr. Implantable cardioverter-defibrillators in patients with Chagas heart disease: misperceptions, many questions and the urgent need for a randomized clinical trial. J Cardiovasc Electrophysiol 2007; 18:1241.
  18. di Toro D, Muratore C, Aguinaga L, et al. Predictors of all-cause 1-year mortality in implantable cardioverter defibrillator patients with chronic Chagas' cardiomyopathy. Pacing Clin Electrophysiol 2011; 34:1063.
  19. Martinelli M, de Siqueira SF, Sternick EB, et al. Long-term follow-up of implantable cardioverter-defibrillator for secondary prevention in chagas' heart disease. Am J Cardiol 2012; 110:1040.
  20. Barbosa MP, da Costa Rocha MO, de Oliveira AB, et al. Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease. Europace 2013; 15:957.
  21. Haedo AH, Chiale PA, Bandieri JD, et al. Comparative antiarrhythmic efficacy of verapamil, 17-monochloracetylajmaline, mexiletine and amiodarone in patients with severe chagasic myocarditis: relation with the underlying arrhythmogenic mechanisms. J Am Coll Cardiol 1986; 7:1114.
  22. Rosenbaum M, Posse R, Sgammini H, et al. [Comparative multicenter clinical study of flecainide and amiodarone in the treatment of ventricular arrhythmias associated with chronic Chagas cardiopathy]. Arch Inst Cardiol Mex 1987; 57:325.
  23. Marin-Neto JA, Rassi JR A, Maciel BC, et al. Chagas heart disease. In: Evidence-Based Cardiology, 3rd ed, Yusuf S, Cairns J, Camm J, et al. (Eds), 2010. p.823.
  24. Benaim G, Paniz Mondolfi AE. The emerging role of amiodarone and dronedarone in Chagas disease. Nat Rev Cardiol 2012; 9:605.
  25. de Paola AA, Melo WD, Távora MZ, Martinez EE. Angiographic and electrophysiological substrates for ventricular tachycardia mapping through the coronary veins. Heart 1998; 79:59.
  26. Sosa E, Scanavacca M, D'Avila A, et al. Endocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia. J Cardiovasc Electrophysiol 1998; 9:229.
  27. de Paola AA, Balbão CE, Castiglioni ML, et al. [Radioisotopic mapping of the arrhythmogenic focus in patients with chronic chagasic cardiomyopathy and sustained ventricular tachycardia]. Arq Bras Cardiol 1993; 60:373.
  28. Milei J, Pesce R, Valero E, et al. Electrophysiologic-structural correlations in chagasic aneurysms causing malignant arrhythmias. Int J Cardiol 1991; 32:65.
  29. Castagnino HE, Cicco JA, Coniglio J, et al. [Chagasic ventricular aneurysm with ventricular tachycardia operated on with good results]. Medicina (B Aires) 1975; 35:166.
  30. Iturralde P, Barragán R, Araya V, et al. [Surgical resection of a focus of ventricular tachycardia guided by endocardial and epicardial mapping]. Arch Inst Cardiol Mex 1992; 62:69.
  31. Andrade JP, Marin Neto JA, Paola AA, et al. I Latin American Guidelines for the diagnosis and treatment of Chagas' heart disease: executive summary. Arq Bras Cardiol 2011; 96:434.
  32. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.
  33. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e385.