Risk progression to chronic Chagas cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction
- A L Basquiera1,
- A Sembaj2,
- A M Aguerri2,
- M Omelianiuk3,
- S Guzmán3,
- J Moreno Barral2,
- T F Caeiro4,
- R J Madoery4,
- O A Salomone4
- 1Internal Medicine Training Programme, Department of Education, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina
- 2Cátedra de Bioquímica y Biología Molecular, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba
- 3Department of Laboratory, Hospital Privado Centro Médico de Córdoba
- 4Department of Cardiology, Hospital Privado Centro Médico de Córdoba
- Correspondence to:
Dr Ana Lisa Basquiera, Hospital Privado Centro Médico de Córdoba, Naciones Unidas 346, 5016 Córdoba, Argentina;
- Accepted 7 May 2003
Background: Polymerase chain reaction (PCR) allows detection of Trypanosoma cruzi in blood throughout the course of Chagas’ disease.
Objective: To determine whether T cruzi DNA detected by PCR is associated with progression to chronic Chagas cardiomyopathy.
Design: Prospective cohort study.
Setting: A tertiary care centre in Argentina.
Patients: 56 consecutive patients with chronic T cruzi infection.
Methods: Clinical examination, ECG, and Doppler echocardiography were carried out at baseline and at the end of the follow up. Detection of T cruzi DNA by PCR amplifying a nuclear sequence was undertaken in all patients at baseline.
Main outcome measures: Progression was defined as death from chronic cardiomyopathy or the presence of a new ECG or left ventricular echocardiographic abnormality at the end of follow up.
Results: The 56 patients (21 male, 35 female; mean (SD) age, 56.0 (11.3) years) were followed for a mean 936.3 (244.39) days. Progression to cardiomyopathy was detected in 12 patients (21.4%). Three of these patients died after baseline evaluation. Univariate analysis showed that a positive PCR (relative risk 4.09, 95% confidence interval (CI) 1.60 to 9.85) and male sex (5.00, 95% CI 1.65 to 15.73) were associated with progression. Multivariable logistic regression indicated that both sex and PCR were independent variables affecting the outcome.
Conclusions: In a cohort of seropositive individuals, patients with T cruzi DNA detected by PCR and male patients were at higher risk of progression. These results highlight the importance of T cruzi in the pathophysiology of chronic cardiomyopathy.