Chagas Disease Cardiomyopathy

Abstract Chronic Chagas disease cardiomyopathy (CCC) is a result of low-intensity, but incessant, focal fibrosing myocarditis, caused by persistent T. cruzi infection associated with inflammation, mediated by adverse immune mechanisms. About 30 percent of infected individuals have developed throughout life the chronic cardiac form of Chagas' disease with protean clinical manifestations, such as sudden death, signs and symptoms of heart failure, cardioembolic events, arrhythmia and angioid symptoms. Sudden death and the progression of heart failure (HF) are the most common mechanisms of death in this condition. The most relevant prognostic aspects are symptoms of advanced HF (NYHA Fc III-IV), cardiomegaly, LV systolic dysfunction and nonsustained ventricular tachycardia. Preventing cardioembolic events is an important aspect in the management of patients with CCC. Oral anticoagulant agents must be prescribed for high-risk patients according to the presence of a set of risk factors: LV systolic dysfunction, apical aneurysm, altered ventricular repolarization by ECG and advanced age. The treatment of HF in patients with CCC follows the same principles applied to HF secondary to dilated cardiomyopathy of other etiologies.摘要：慢性恰加斯病心肌病（CCC）是由持续存在的克氏锥虫（T. cruzi）感染引发的低强度、持续性局灶性纤维性心肌炎的病理结局，其发病机制为不良免疫介导的炎症过程。约30%的感染者在终身病程中会发展为慢性心脏型恰加斯病，临床表现呈多形性，涵盖猝死、心力衰竭的体征与症状、心源性栓塞事件、心律失常以及类心绞痛症状。猝死与心力衰竭（HF）进展是该病症最常见的致死机制。最为关键的预后评估指标包括晚期心力衰竭症状（纽约心脏协会（NYHA）心功能分级Ⅲ~Ⅳ级）、心脏扩大、左心室收缩功能障碍以及非持续性室性心动过速。预防心源性栓塞事件是慢性恰加斯病心肌病患者临床管理的重要环节。对于存在一组高危因素的患者，需为其开具口服抗凝药物处方，这些高危因素包括：左心室收缩功能障碍、心尖部室壁瘤、心电图提示心室复极异常以及高龄。慢性恰加斯病心肌病患者的心力衰竭治疗，遵循与其他病因所致扩张型心肌病继发的心力衰竭相同的治疗原则。