Chronic Chagas’ Myocardiopathy

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Abstract
Chagas'' disease (CHDis) has been described as the most common form of chronic myocarditis. Although autoimmune phenomena involving the myocardium were suggested in both human and experimental ChDis, no immunoperoxidase techniques were used for the detection of immunological deposits in chronic Chagas'' myocardiopathy (ChrCHM). The coincidence between the immunoperoxidase and the immunofluorescence techniques in evidencing autologous deposits in ChrCHM was studied. Patients (4) suffering from ChrCHM were selected; ages ranged from 39 to 52 yr (.hivin.x: 48.5 yr). The Shultze and Caves endocavitary bioptome via the right internal jugular vein was used to obtain 3-4 right endomycardial specimens measuring 1-2 mm each. Direct immunofluorescence examination, immunoperoxidase technique (PAP) and routine histological procedure were performed in all cases. Agreement between immunofluorescence and immunoperoxidase techniques was present in all chagasic specimens studied. Patients suffering from ChrCHM showed deposits of IgG, IgA, IgM and C3 at the interstitial area, capillaries and endocardium and/or myocardial fiber surfaces when serum EVI antibody was positive. Serum EVI antibody was found to be positive in 3 out of 4 patients. The presence of the complement together with Ig may suggest an immune action (in vivo bound Ig in heart structures) and not just a passive deposition secondary to myocardial damage. As EVI antibody is present to a significant extent in CHDis, a reliable and simple technique like immunoperoxidase may be helpful to clarify the role of these antibodies in the pathogenesis of CHDis.

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