Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
DOI:
https://doi.org/10.1590/SciELOPreprints.4820Keywords:
Cardiomyopathy of Chagas disease, Indeterminate form of Chagas disease, Oral Transmission, T. cruzi, Risk Stratification, Trypanosytreatment, Heart failure, Arrhythmias, Thromboembolism, Heart transplantsAbstract
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
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Copyright (c) 2022 José Antonio Marin-Neto, Anis Rassi Jr., Gláucia M. Moraes Oliveira, Luís Claudio Lemos Correia, Alberto Novaes Ramos Jr., Alejandro Marcel Hasslocher-Moreno, Alejandro Luquetti Ostermayer, Andréa Silvestre de Sousa Silvestre de Sousa, Angelo Amato Vincenzo de Paola, Antonio Carlos Sobral de Sousa, Antonio Luiz Pinho Ribeiro, Dalmo Correia Filho, Dilma do Socorro Moraes de Souza, Edecio Cunha-Neto, Felix J. A. Ramires, Fernando Bacal, Maria do Carmo Pereira Nunes, Martino Martinelli Filho, Maurício Ibrahim Scanavacca, Roberto Magalhães Saraiva, Wilson Alves de Oliveira Júnior, Adalberto M. Lorga-Filho, Adriana de Jesus Benevides de Almeida Guimarães, Adriana Lopes Latado Braga, Adriana Sarmento de Oliveira, Alvaro V. L. Sarabanda, Ana Yecê das Neves Pinto, André Assis Lopes do Carmo, André Schmidt, Barbara Maria Ianni, Brivaldo Markman Filho, Carlos Eduardo Rochitte, Carolina Thé Macedo, Charles Mady, Christophe Chevillard, Cláudio Marcelo Bittencourt das Virgens, Cleudson Nery de Castro, Constança Felícia De Paoli de Carvalho Britto, Cristiano Pisani, Daniela do Carmo Rassi, Dario C. Sobral Filho, Dirceu Rodrigues Almeida, Edimar A. Bocchi, Evandro T. Mesquita, Fernanda de Souza Nogueira Sardinha Mendes, Francisca Tatiana Pereira, Gilberto Marcelo Sperandio da Silva, Giselle de Lima Peixoto, Gustavo Glotz de Lima, Henrique H. Veloso, Henrique Turin Moreira, Hugo Bellotti Lopes, Ibraim Masciarelli Francisco Pinto, João Carlos Pinto Dias, João Marcos Bemfica, João Paulo Silva-Nunes, José Augusto Soares Barreto-Filho, José Francisco Kerr Saraiva, Joseli Lannes-Vieira, Joselina Luzia Menezes Oliveira, Luciana V. Armaganijan, Luiz Cláudio Martins, Luiz Henrique C. Sangenis, Marco Paulo Barbosa, Marcos Antônio Almeida-Santos, Marcos Vinicius Simões, Maria Aparecida Shikanai-Yasuda, Maria da Consolação Vieira Moreira, Maria de Lourdes Higuchi, Maria Rita de Cássia Costa Monteiro, Mauro Felippe Felix Mediano, Mayara Maia Lima, Maykon T. Oliveira, Minna Moreira Dias Romano , Nadjar Nitz, Paulo de Tarso Jorge Medeiros, Renato Vieira Alves, Ricardo Alkmim Teixeira, Roberto Coury Pedrosa, Roque Aras, Rosália Morais Torres, Rui Manoel dos Santos Povoa, Sérgio Gabriel Rassi, Sérgio Salles Xavier, Silvia Marinho Martins Alves , Suelene B. N. Tavares, Swamy Lima Palmeira, Telêmaco Luiz da Silva Junior, Thiago da Rocha Rodrigues, Vagner Madrini Junior, Veruska Maia da Costa , Walderez Dutra
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