Abstract 4368550: Screening for Chagas Cardiomyopathy in a Community in Northern Argentina

Abstract

Introduction: Chagas disease is a vector-borne parasitic infection endemic to Latin America. After acute infection resolves, approximately 30% of patients may progress to the chronic symptomatic phase and develop potentially fatal cardiac complications decades later. Predisposition to developing Chagas cardiomyopathy is poorly understood and screening remains an ongoing challenge. We sought to characterize the prevalence of Chagas cardiomyopathy in a rural Chagas-endemic community in northern Argentina. Methods: A cross-sectional study in Chancaní, Córdoba province, Argentina was conducted. Patients were recruited in collaboration with regional health officials through the local health center. Patient history and current health status, serological, cardiovascular examination, 12-lead electrocardiogram (ECG), and transthoracic color Doppler echocardiogram data (TTE) were collected. Both chemiluminescence and hemagglutinin inhibition testing for Chagas disease were conducted on blood samples. Patients who were found to have Chagas disease were referred for treatment and further management. Results: Data was collected from 159 patients, of which 35.8% had Chagas disease by serology. Of the patients with Chagas disease, 57.8% were female. Notably, 61.4% of serologically positive Chagas patients were aware of their diagnosis and only 14.0% had undergone treatment. Chagas-positive patients tended to be older than patients without Chagas (52.7 vs 44.4 years, p < 0.01). ECG analysis demonstrated 38.5% of Chagas patients had conduction abnormalities. Patients with Chagas disease tended to have greater left ventricular septal and posterior wall thickness than patients without Chagas disease (0.83 vs 0.78 and 0.84 vs. 0.78 cm respectively; p < 0.05). There were no statistically significant differences in left ventricular ejection fraction, left ventricular end-diastolic diameter, left atrial volume, E/A ratio, E/e’ ratio, or mid right ventricular diameter on TTE between patients with and without Chagas disease. Conclusion: Screening for Chagas disease in an endemic area revealed that majority of patients with Chagas disease are unaware of their diagnosis and are vastly undertreated. Most patients screened were in the indeterminate chronic form of the disease and were without significant structural or electrical cardiac abnormalities. We plan to conduct serial examinations, including ECG and TTE, to identify predictors for the development of Chagas cardiomyopathy.