Chagasic Cardiomyopathy Is Independently Associated With Ischemic Stroke in Chagas Disease

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Abstract
Background and Purpose— Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. American trypanosomiasis, Chagas disease (CD), is a major public health problem in South America. We sought to evaluate prevalence of vascular risk factors for stroke in patients with stroke caused by CD. Methods— Ninety-four consecutive CD stroke patients and 150 consecutive nonchagasic stroke patients were studied. CD was confirmed when both immunofluorescence and hemagglutination serology were positive. Data collected included age, sex, vascular risk factors, diagnostic stroke subtype (TOAST classification), and echocardiography findings. Fasting plasma levels of protein C, protein S, antithrombin III, homocysteine, activated protein C resistance, IgG anticardiolipin antibodies, lupus anticoagulant, and genetic tests for the factor V Leiden and the C677T methylene tetrahydrofolate reductase gene mutation were determined. Results— CD patients had a mean age of 56.31 years compared with 61.59 years for non-CD stroke patients ( P =0.0002). Cardioembolism occurred in 56.38% of CD stroke patients compared with 9.33% in controls ( P =0.000), whereas atherothrombotic strokes occurred in 8.51% of CD strokes versus 20% in controls ( P =0.016), and small-vessel stroke in 9.57% of CD stroke patients versus 34.67% in controls ( P =0.000). Apical aneurysm (37.23% versus 0.67%; OR, 88.39), left ventricular dilatation (23.4% versus 5.33%; OR, 5.42), mural thrombus (11.7 versus 2%; OR, 6.49) and abnormal electrocardiography (ECG) (66% versus 23.33%; OR, 2.87) were significantly higher in the group of chagasic stroke patients. No statistical differences were observed in thrombophilia between both groups. The significant variables that predicted CD stroke patients on a stepwise logistical regression model were apical aneurysm, cardiac insufficiency, ECG arrhythmia, female gender, and hypertension. Conclusions— Chagasic cardiomyopathy is independently associated with ischemic stroke, whereas hypercoagulable states do not appear to be major contributors to the excess stroke risk seen in patients with CD.