Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBCcMKwvNJC6jtzSYXCXBbcHYPS0066-782X201800030029710.5935/abc.20180029Letter to the EditorOccurrence of Stroke and Reduced Ejection Fraction in Patients with Chagas DiseaseSampaioElieusa e SilvaOliveiraMárcia Maria CarneiroArasRoqueUniversidade Federal da BahiaSalvadorBABrazilUniversidade Federal da Bahia, Salvador, BA - BrazilUniversidade Federal da BahiaMailing Address: Elieusa e Silva Sampaio, Rua General Braulio Guimarães, 224. Edf. Ocean Ville. Aptº 301. Postal Code 41750-000, Jardim Armação, Salvador, BA - Brazil E-mail: elieusasampaio@uol.com.br, eesampaio@ufba.br0320181103297297290920171810201718102017This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedKeywordsChagas DiseaseChagas CardiomyopathyStrokeStroke Volume
To the Editor
Chagas disease (CD) is a well-defined risk factor for stroke.1 But the prognostic significance of stroke prevalence in left ventricular ejection fraction (LVEF) reduced compared to preserved LVEF in patients with heart failure and with CD, is still poorly known.2
There are studies that demonstrate the association of stroke with CD and reduced LVEF3 and there are studies that refute this association.4 In a cross-sectional study involving 85 chagasic patients with a mean age of 61.8 ± 9.3 years, 71.8% with heart failure and 96.5% of black race, patients were compared with LVEF ≤ 40% and LVEF > 40% to evaluate stroke occurrence in patients with CD and reduced LVEF. It was shown that LVEF ≤ 40% (OR 4.37: 1.65-11.63; p = 0.003) was an independent predictor for stroke compared to patients with preserved LVEF. There was also a high prevalence (50%) of CVA, which was obtained by cranial tomography, a number close to a cohort of 41.6% in the same town.5 There were no hemorrhagic strokes and there was also no significant relationship between fibrillation atrial and stroke, this data can be explained by the use of oral anticoagulants in these patients. In addition, 54.8% of silent vascular accidents were detected in patients who had no history of stroke. The high prevalence of stroke in this study with chagasic patients may have occurred because all patients were evaluated with cranial tomography, contrary to other studies, which generally use clinical and/or radiological findings as diagnostic criteria for stroke1,4 and do not usually evaluate silent cerebral infarction.4 Data suggest that reduced LVEF is associated with stroke, confirmed by cranial tomography and may be an independent predictor of embolic events in this population.
References1 Carod-Artal FJ, Vargas AP, Horan TA, Nunes LG. Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. Stroke. 2005;36(5):965-70. doi: 10.1161/01.STR.0000163104.92943.50.Carod-ArtalFJVargasAPHoranTANunesLGChagasic cardiomyopathy is independently associated with ischemic stroke in Chagas diseaseStroke200536596597010.1161/01.STR.0000163104.92943.502 Cardoso RN, Macedo FY, Garcia MN, Garcia DC, Benjo AM, Aguilar D, et al. Chagas cardiomyopathy is associated with higher incidence of stroke: a meta-analysis of observational studies. J Card Fail. 2014;20(12):931-8. doi: 10.1016/j.cardfail.2014.09.003.CardosoRNMacedoFYGarciaMNGarciaDCBenjoAMAguilarDChagas cardiomyopathy is associated with higher incidence of stroke: a meta-analysis of observational studiesJ Card Fail2014201293193810.1016/j.cardfail.2014.09.0033 Nunes MC, Barbosa MM, Ribeiro AL, Barbosa FB, Rocha MO. Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study. J Neurol Sci. 2009;278(1-2):96-101. doi: 10.1016/j.jns.2008.12.015.NunesMCBarbosaMMRibeiroALBarbosaFBRochaMOIschemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up studyJ Neurol Sci20092781-29610110.1016/j.jns.2008.12.0154 Nunes MC, Kreuser LJ, Ribeiro AL, Sousa GR, Costa HS, Botoni FA, et al. Prevalence and risk factors of embolic cerebrovascular events associated with Chagas heart disease. Glob Heart. 2015;10(3):151-7. doi: 10.1016/j.gheart.2015.07.006.NunesMCKreuserLJRibeiroALSousaGRCostaHSBotoniFAPrevalence and risk factors of embolic cerebrovascular events associated with Chagas heart diseaseGlob Heart201510315115710.1016/j.gheart.2015.07.0065 da Matta JA, Aras R Jr, de Macedo CR, da Cruz CG, Netto EM. Stroke correlates in Chagasic and non-Chagasic cardiomyopathies. PLoS One. 2012;7(4):e35116. doi: 10.1371/journal.pone.0035116.da MattaJAArasRJrde MacedoCRda CruzCGNettoEMStroke correlates in Chagasic and non-Chagasic cardiomyopathiesPLoS One201274e3511610.1371/journal.pone.0035116Carta ao EditorOcorrência de Acidente Vascular Cerebral e Fração de Ejeção Reduzida em Pacientes com Doença de ChagasSampaioElieusa e Silva2OliveiraMárcia Maria Carneiro2ArasRoque2Universidade Federal da Bahia, Salvador, BA - BrasilCorrespondência: Elieusa e Silva Sampaio, Rua General Braulio Guimarães, 224. Edf. Ocean Ville. Aptº 301. CEP 41750-000, Jardim Armação, Salvador, BA - Brasil E-mail: elieusasampaio@uol.com.br, eesampaio@ufba.brPalavras-chaveDoença de ChagasCardiomiopatia ChagásicaAcidente Vascular CerebralVolume Sistólico
Ao Editor
A Doença de Chagas (DC) é um fator de risco bem definido para Acidente Vascular Cerebral (AVC).1 Mas o significado prognóstico da prevalência de AVC na fração de ejeção do ventrículo esquerdo (FEVE) reduzida em comparação com a FEVE preservada em pacientes com insuficiência cardíaca e com DC, ainda é pouco conhecido.2
Há estudos que demonstram associação do AVC com DC e com FEVE reduzida3 e há os que refutam esta associação.4 Em um estudo transversal, envolvendo 85 pacientes chagásicos com média de idade de 61,8 ± 9,3 anos, sendo 71,8% com insuficiência cardíaca e 96,5% da raça negra, os pacientes foram comparados com a FEVE ≤ 40% e FEVE > 40%, para avaliar a ocorrência de AVC em pacientes com DC e FEVE reduzida. Evidenciou-se que a FEVE ≤ 40% (OR 4,37: 1,65-11,63; p = 0,003) foi um preditor independente para AVC em comparação com pacientes com FEVE preservada. Observou-se ainda uma alta prevalência (50%) de AVC a qual obtida pela tomografia de crânio, número próximo a uma coorte de chagásicos de 41,6% na mesma localidade.5 Não houve AVCs hemorrágicos e também não houve relação significativa entre fibrilação atrial e AVC, este dado pode ser explicado pelo uso de anticoagulantes orais nestes pacientes. Além disso, foram detectados 54,8% de acidentes vasculares silenciosos em pacientes que não tinham história de AVC. A alta prevalência de AVC neste estudo com pacientes chagásicos, pode ter acontecido porque todos os pacientes foram avaliados com tomografia de crânio, ao contrário de outros estudos, que geralmente utilizam como critérios de diagnóstico de AVC os achados clínicos e/ou radiológicos1,4 e comumente não avaliam o infarto cerebral silencioso.4 Os dados sugerem que a FEVE reduzida está associada ao AVC, confirmado por meio de tomografia de crânio e pode ser um preditor independente de eventos embólicos nesta população.