Chagas Disease/physiopathology

IJCS

Original Article

Association of Anti-β1 and Anti-M2 Antibodies with Autonomic Nervous System Modulation in Patients with Chronic Chagas Cardiomyopathy

Delma Maria Cunha et al. Pedro Cunha Tzirulnik Patricia Cristina dos Santos Costa Danton Machado Cunha Ademir Batista da Cunha

Abstract

Background:

Different immune mechanisms of myocardial damage involved in the pathophysiology of Chagas disease coexist with high titers of autoantibodies induced by T. cruzi . There are few studies in the literature about the adaptive role of anti-β1 and anti-M2 antibodies in chronic Chagas cardiomyopathy (CCC).

Objectives:

To evaluate the association between anti-β1 and anti-M2 antibodies with heart rate variability (HRV) parameters on 24h Holter monitoring and the rate-pressure product (RPP) on cardiopulmonary exercise testing (CPET).

Methods:

Anti-β1 and anti-M2 antibody titers were measured by enzyme-linked immunosorbent assay (ELISA) in 64 patients affected by CCC. Analysis of HRV was performed through the time-domain indices NNs, mean NN, SDNN, SDANN, SDNN index, NNNs, RMSSD, and pNN50. Spearman’s correlation coefficient was used to assess the association between antibody titers and numerical variables. The Mann–Whitney test was used for comparison between two groups. Multiple linear regression was used to identify independent variables capable of explaining anti-β1 and anti-M2 antibody titers at the 5% significance level.

Results:

On 24h Holter, during the period of greatest parasympathetic activation (2:00-6:00 a.m.), an inverse association was found between anti-β1 titers and SDNN (r_s=-0.13, p =0.041, n=43), as well as a direct association between anti-M2 titers and SDANN ( r _s=0.317, p =0.039, n=43). Regarding CPET variables, anti-β1 titers were directly associated with RPP (r_s=0.371, p =0.005, n=56). The subgroup of patients with a normal chronotropic response showed higher anti-β1 titers than the subgroup with an impaired response (p=0.023). RPP was an independent explanatory variable for anti-β1 titers, although with a low coefficient of determination (R²=0.147).

Conclusion:

The findings of this study suggest that, in patients with CCC, anti-β1 and anti-M2 antibodies may affect HRV parameters. RPP was directly associated with higher anti-β1 titers.

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Original Article

Correlation between Cardiomegaly on Chest X-Ray and Left Ventricular Diameter on Echocardiography in Patients with Chagas Disease

Matheus Rassi Fernandes Ramos et al. Henrique Turin Moreira Gustavo Jardim Volpe Minna Romano … Benedito Carlos Maciel André Schmidt Anis Rassi Junior Jose Antônio Marin Neto

Abstract

Background

Cardiomegaly on chest X-ray is an independent predictor of death in individuals with chronic Chagas cardiomyopathy (CCC). However, the correlation between increased cardiothoracic ratio (CTR) on chest X-ray and left ventricular end-diastolic diameter (LVEDD) on echocardiography is not well established in this population.

Objectives

To assess the relationship between chest X-ray and LVEDD on echocardiography in patients with Chagas disease and its applicability to the Rassi score.

Methods

Retrospective study on 63 Chagas disease outpatients who underwent chest X-ray and echocardiography. Cardiomegaly on chest X-ray was defined as a CTR>0.5. LVEDD was analyzed as a continuous variable. ROC curve was used to evaluate the ability of LVEDD in detecting cardiomegaly by chest X-ray, with a cut-off point defined by the highest sum of sensitivity and specificity.

Results

Median age 61 years [interquartile range 48-68], 56% were women. CCC was detected in 58 patients, five patients had the indeterminate form of Chagas disease. Cardiomegaly was detected in 28 patients. The area under the ROC curve for LVEDD was 0.806 (95%CI: 0.692-0.919). The optimal cut-off for LVEDD was 60 mm (sensitivity = 64%, specificity = 89%). The use of LVEDD on echocardiography as a surrogate for CTR on chest X-ray changed the Rassi score values of 14 patients, with a reduction in the presumed risk in 10 of them.

Conclusion

LVEDD on echocardiography is an appropriate, highly specific parameter to distinguish between the presence and absence of cardiomegaly on chest X-ray in Chagas disease. (Arq Bras Cardiol. 2021; 116(1):68-74)

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Original Article

Lower Prevalence and Severity of Coronary Atherosclerosis in Chronic Chagas’ Disease by Coronary Computed Tomography Angiography

Savio Cardoso et al. Clerio Francisco de Azevedo Filho Fábio Fernandes Barbara Ianni … Jorge Andion Torreão Mateus Diniz Marques Luiz Francisco Rodrigues de Ávila Raul Santos Filho Charles Mady Roberto Kalil-Filho José Antônio Franchine Ramires Marcio Sommer Bittencourt Carlos E. Rochitte

Abstract

Background

In Chagas’ disease endemic regions, there has been for many years a recurrent empirical observation that coronary artery disease (CAD) is uncommon in patients with Chagas’ disease. Previous pathological and invasive coronary angiography studies led to controversial results.

Objective

We sought to investigate whether CAD is less prevalent and less severe in patients with chronic Chagas’ disease when compared with a matched population with a similar CAD risk profile.

Methods

A total of 86 participants, 43 consecutive patients with chronic Chagas’ disease and 43 asymptomatic individuals, without any prior history of cardiac disease or known CAD (control group), were included. Patients and controls were matched according to gender, age, and Framingham risk score. All participants underwent coronary calcium scoring and coronary computed tomography angiography on a 320-row detector scanner. Statistical significance level adopted was p < 0.05.

Results

The coronary artery calcium score (CACS) was significantly lower in patients with Chagas’ disease than in controls (p 10 (OR: 0.11, 95%CI: 0.01-0.87, p=0.04) and for the presence of any stenosis (OR: 0.06, 95%CI: 0.01-0.47, p=0.001). Propensity score matching also indicated an effect of Chagas disease on the CACS (-21.6 points in the absolute score and 25% less of patients with CACS >10, p=0.015).

Conclusions

CAD is less prevalent and less severe in patients with chronic Chagas’ disease when compared with a matched population with a similar CAD risk profile. (Arq Bras Cardiol. 2020; 115(6):1051-1060)

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Editorial

Absence of Atherosclerosis in Chagas’ Disease: The Role of Trypanosoma Cruzi Transialidase

Maria de Lourdes Higuchi

The paper Lower Prevalence and Severity of Coronary Atherosclerosis in Chronic Chagas’ Disease by Coronary Computed Tomography Angiographyreveals a very important data: patients with Chagas disease have much lower atherosclerosis compared with a carefully matched population of individuals without Chagas disease. Analyzing 43 patients prospectively, 93% of Chagas disease patients had absence of coronary artery disease (CAD) plaques, 7% mild to moderate obstruction and zero cases of severe obstruction. It endorses our previous pathological datain few autopsy hearts, confirming that Chagas disease patients do not have atherosclerosis. Why they do not present atherosclerosis?

The main enzyme produced by Trypanosoma cruzi ( T. cruzi ) is trans-sialidase. It removes syalic acid from the tissue to the circulation. Microbiota has been associated with the development of atherosclerosis.Mycoplasma is known to grow in cholesterol-rich media and in our previous study we observed large amounts of mycoplasmas in fat atheroma.Many infectious agents such as mycoplasma and viruses such as SARS CoV-2 uses the syalic acid to enter the host cell, the transialidase from T. cruzi may remove mycoplasmas from the atheroma plaques, preventing development of atheroma.We created a nutricosmetic associating the enzyme transialidase and natural antioxidant nanoparticles and decreased experimental atherosclerosis in rabbits.^,

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Original Article

Absence of Nocturnal Fall in Blood Pressure Detected by Ambulatory Blood Pressure Monitoring in Acute Chagas Disease Patients with Oral Infection

Dilma do S. M. de Souza et al. Céres Larissa Barbosa de Oliveira Brenda Gonçalves Maciel Maria Tereza Figueiredo … Henrique Tria Bianco Francisco A. H. Fonseca Maria Cristina Izar Rui M. S. Póvoa

Abstract

Background

The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed.

Objetives

To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall.

Methods

ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%.

Results

In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05).

Conclusions

In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715)

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