Produção Nacional
Revisado por pares
Assessment of the source of ischemic cerebrovascular events in patients with Chagas disease
2014; Elsevier BV; Volume: 176; Issue: 3 Linguagem: Inglês
10.1016/j.ijcard.2014.07.266
ISSN1874-1754
AutoresJosé Olímpio Dias, Manoel Otávio da Costa Rocha, Aline Cristina de Souza, Lucas Jordan Kreuser, Laura Alves de Souza Dias, Timothy C. Tan, Antônio Lúcio Teixeira, Maria Carmo Pereira Nunes,
Tópico(s)Cardiomyopathy and Myosin Studies
ResumoChagas disease (ChD) remains a major public health problem in Latin America and it is an emerging disease in non-endemic countries [ [1] Schmunis G.A. Yadon Z.E. Chagas disease: a Latin American health problem becoming a world health problem. Acta Trop. Jul-Aug 2010; 115: 14-21 Crossref PubMed Scopus (596) Google Scholar ]. ChD is an important cause of ischemic cerebrovascular events (ICE), which result in a substantial long-term disability [ 2 Nunes M.C. Barbosa M.M. Ribeiro A.L. Barbosa F.B. Rocha M.O. Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study. J Neurol Sci. Mar 15 2009; 278: 96-101 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar , 3 Paixao L.C. Ribeiro A.L. Valacio R.A. Teixeira A.L. Chagas disease: independent risk factor for stroke. Stroke. Dec 2009; 40: 3691-3694 Crossref PubMed Scopus (45) Google Scholar , 4 Carod-Artal F.J. Vargas A.P. Horan T.A. Nunes L.G. Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. Stroke. May 2005; 36: 965-970 Crossref PubMed Scopus (118) Google Scholar , 5 Souza A.C. Rocha M.O. Teixeira A.L. Dias Junior J.O. Sousa L.A. Nunes M.C. Depressive symptoms and disability in chagasic stroke patients: impact on functionality and quality of life. J Neurol Sci. Jan 15 2013; 324: 34-37 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ] and risk of death [ [6] Lima-Costa M.F. Matos D.L. Ribeiro A.L. Chagas disease predicts 10-year stroke mortality in community-dwelling elderly: the Bambui cohort study of aging. Stroke. Nov 2010; 41: 2477-2482 Crossref PubMed Scopus (50) Google Scholar ]. Cardioembolic source for thrombi is considered to be the main pathophysiological mechanism, related to apical aneurysms, heart failure and arrhythmias [ [2] Nunes M.C. Barbosa M.M. Ribeiro A.L. Barbosa F.B. Rocha M.O. Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study. J Neurol Sci. Mar 15 2009; 278: 96-101 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar ]. However, ChD also compromises microvasculature function, which may contribute to the risk of ischemic events [ [7] Hassan G.S. Mukherjee S. Nagajyothi F. et al. Trypanosoma cruzi infection induces proliferation of vascular smooth muscle cells. Infect Immun. Jan 2006; 74: 152-159 Crossref PubMed Scopus (32) Google Scholar ]. The vascular dysfunction in Chagas disease is multifactorial, involving infection-associated microvascular spasm, reduction in blood flow, increased platelet aggregation, and increased myocardial inflammation and fibrosis [ [7] Hassan G.S. Mukherjee S. Nagajyothi F. et al. Trypanosoma cruzi infection induces proliferation of vascular smooth muscle cells. Infect Immun. Jan 2006; 74: 152-159 Crossref PubMed Scopus (32) Google Scholar ]. Although vascular inflammatory injuries have been associated with Trypanosoma cruzi infection in animal experimental studies [ [8] Tanowitz H.B. Kaul D.K. Chen B. et al. Compromised microcirculation in acute murine Trypanosoma cruzi infection. J Parasitol. Feb 1996; 82: 124-130 Crossref PubMed Scopus (70) Google Scholar ], the association between the vasculopathy in Chagas disease and ischemic events has not been studied in a clinical setting.
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