Chagas disease in Virgem da Lapa, Minas Gerais, Brazil: left ventricle aneurysm and the risk of death in the 24-year interval

Left ventricular aneurysm (LVA) is indicator of high morbidity in Chagas’ disease. A cross-sectional study performed identified LVA in 18.8% of the chronic chagasic patients (CCP).

OBJECTIVE

Determine the risk of death of patients with chronic chagasic cardiopathy (CCC) and LVA in 24-year interval.

MATERIAL AND METHODS

In 1995 a cohort of 298 CCP was evaluated by anamnesis, physical examination, EKG and ECHO and classified in groups: G0 = 86 without cardiopathy; G1 = 156 with cardiopathy without LVA and G2 = 56 with cardiopathy and LVA. 38 patients of G0 and G1 used benznidazole. Information about the deaths was obtained in the notary, death certificates, hospital records and family members.

FINDINGS

Were registered 113 deaths (37.9%): 107 (35.9%) attributed to cardiopathy and 6 (2.0%) to other causes (p < 0.05). Amongst these 107 deaths, 10 (11.6%) occurred in G0; 49 (31.4%) occurred in G1 and 48 (85.7%) occurred in G2 (p < 0.05). The risk of death was 2.7 and 7.4 times significantly higher in G2, than in G1 and G0, respectively.

CONCLUSION

Chronic chagasic patients with LVA and ejection fraction < 45% have a higher risk of death than those without.

Key words:
Chagas disease; left ventricle aneurysm; risk of death; Virgem da Lapa; MG

Authorship

José Borges-Pereira ⁺+ Corresponding author: borges@ioc.fiocruz.br - jborgespereira207@gmail.com

Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz-FiocruzBrazilRio de Janeiro, RJ, BrazilFundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil

https://orcid.org/0000-0002-6153-5661

José Rodrigues Coura

Patrícia Lago Zauza

Claude Pirmez

Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz-FiocruzBrazilRio de Janeiro, RJ, BrazilFundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil

Sérgio Salles Xavier

Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Doença de Chagas, Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz-FiocruzBrazilRio de Janeiro, RJ, BrazilFundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Doença de Chagas, Rio de Janeiro, RJ, Brasil

+ Corresponding author: borges@ioc.fiocruz.br - jborgespereira207@gmail.com

JBP, JRC, PLZ, CP and SSX, all authors, were responsible for the design, implementation, obtaining results, analysis and interpretation of data, reading and final approval of the article. The authors declare no conflicts of interest.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (3)
Tables (4)

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Fig. 1:
location of the study area (1- Virgem da Lapa) in the State of Minas Gerais, Brazil, and the municipalities bordering: 2- Grão Mogol; 3- Rubilita; 4- Coronel Murta; 5- Araçuaí; 6- Francisco Badaró; 7- Berilo; 8- Josenópolis.

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Fig. 2:
cumulative survival curves in groups of chronic chagasic patients: G0 - patients without cardiopathy; G1 - patients with cardiopathy without left ventricle aneurysms; G2 - patients with cardiopathy and left ventricle aneurysms. Statistical analysis: G2 vs G1; X² = 48.96; p = 0,0000; RR = 2.72 (IC = 2.11 < RR< 3.52).

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Fig. 3:
left ventricular apical aneurysm: (A) in the patient 2496, MNT, female, 43 years old, white, ejection fraction = 43%, electrocardiogram (EKG) with complete blockage of the right branch and ventricular extra-systoles, sudden death 98 months after diagnosis and (B) in the patient 1845, MDPJ, female, 63 years old, black, ejection fraction = 43%, EKG with complete blockage of the right branch, left anterior hemiblock and ventricular extra-systoles to pairs, sudden death 36 months after diagnosis.

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TABLE I
Characteristics of the groups of patients on 1995, Virgem da Lapa, Minas Gerais, Brazil

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TABLE II
Causes of deaths recorded in the cohort of chronic chagasic patients in the 24-year interval (1995-2019), Virgem da Lapa, Minas Gerais, Brazil

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TABLE III
Percentage of deaths to cardiopathy in groups of chronic Chagas patients of Virgem da Lapa-MG, Brazil, in the interval of 24 years (1995-2019)

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TABLE IV
Percentage of death to cardiopathy on groups G1 and G2 of chronic chagasic patients, on interval 24 years (1995-2019), according with some variables, Virgem da Lapa, Minas Gerais, Brazil

Fig. 1: location of the study area (1- Virgem da Lapa) in the State of Minas Gerais, Brazil, and the municipalities bordering: 2- Grão Mogol; 3- Rubilita; 4- Coronel Murta; 5- Araçuaí; 6- Francisco Badaró; 7- Berilo; 8- Josenópolis.

Fig. 2: cumulative survival curves in groups of chronic chagasic patients: G0 - patients without cardiopathy; G1 - patients with cardiopathy without left ventricle aneurysms; G2 - patients with cardiopathy and left ventricle aneurysms. Statistical analysis: G2 vs G1; X² = 48.96; p = 0,0000; RR = 2.72 (IC = 2.11 < RR< 3.52).

Fig. 3: left ventricular apical aneurysm: (A) in the patient 2496, MNT, female, 43 years old, white, ejection fraction = 43%, electrocardiogram (EKG) with complete blockage of the right branch and ventricular extra-systoles, sudden death 98 months after diagnosis and (B) in the patient 1845, MDPJ, female, 63 years old, black, ejection fraction = 43%, EKG with complete blockage of the right branch, left anterior hemiblock and ventricular extra-systoles to pairs, sudden death 36 months after diagnosis.

TABLE I Characteristics of the groups of patients on 1995, Virgem da Lapa, Minas Gerais, Brazil

Characteristics	Group G0 (n = 86)		Group G1 (n = 156)		Group G2 (n = 56)		Statistical analysis G1 x G2
Characteristics	Total	%	Total	%	Total	%	X² =	p < 0,05
Gender
Female	59	68.6	96	61.5	29	51.8	1.61	No
Male	27	31.4	60	38.5	27	48.2
Age (years)
13-50	57	66.3	57	36.5	31	55.4	6.01	Yes
> 50	29	33.7	99	63.5	25	44.6
Arterial hypertension
Present	9	10.5	47	30.1	11	19.6	2.27	No
Absent	77	89.5	109	69.9	45	80.4
Ventricular extrasystoles
Present	0		49	31.4	32	57.1	11,5	Yes
Absent	86	100.0	107	68.6	24	42.9
CBRB + LAH
Present	0		61	39.1	22	39.3	0.006	No
Absent	86	100.0	95	60.9	34	60.7
Ejection fraction < 45%
Present	0		9	5.8	21	37.5	34.15	Yes
Absent	86	100.0	147	94.2	35	62.5

G0: patients without cardiopathy; G1: patients with cardiopathy without left ventricle aneurysms; G2: patients with cardiopathy and left ventricle aneurysms; X² = non-corrected chi-square; p < 0.05; Yes: significant statistical difference); no: non-statistically significant difference; CBRB + LAH: complete blockage of the right branch + left anterior hemiblock.

TABLE II Causes of deaths recorded in the cohort of chronic chagasic patients in the 24-year interval (1995-2019), Virgem da Lapa, Minas Gerais, Brazil

Causes of deaths recorded	Group G0	Group G1	Group G2	Total
To cardiopathy	10	49	48	107
Sudden death	2	19	18	39
Ignored	4	6	5	15
Acute myocardial infarction	0	3	2	5
Congestive heart failure	2	5	7	14
Acute lung edema	0	0	3	3
Chronic Chagas heart disease	0	9	6	15
Stroke	2	3	5	10
Chagas disease	0	3	1	4
Cardiorespiratory arrest	0	1	1	2
To other causes	2	4	0	6
Acute pancreatitis	0	1	0	1
Esophageal cancer	0	1	0	1
Septicemia	0	2	0	2
Pneumonia	1	0	0	1
Liver cirrhosis	1	0	0	1
TOTAL	12	53	48	113

G0: patients without cardiopathy; G1: patients with cardiopathy without left ventricle aneurysms; G2: patients with cardiopathy and left ventricle aneurysms.

TABLE III Percentage of deaths to cardiopathy in groups of chronic Chagas patients of Virgem da Lapa-MG, Brazil, in the interval of 24 years (1995-2019)

Group of patients	Number	Death	% death
G0 - without cardiopathy	86	10	11.6
G1 - with cardiopathy without left ventricle aneurysms	156	49	31.4
G2 - with cardiopathy and left ventricle aneurysms	56	48	85.7
TOTAL	298	107	35.9

G2 vs G1: X² = 48.96; p = 0.000; risk ratio = 2.72.

TABLE IV Percentage of death to cardiopathy on groups G1 and G2 of chronic chagasic patients, on interval 24 years (1995-2019), according with some variables, Virgem da Lapa, Minas Gerais, Brazil

Variables	Group G1 (n = 156)			Group G2 (n = 56)			Statistical analysis*
Variables	total	death*	% death	total	death*	% death	RR =	p < 0.05
Gender
Female	96	31	32.3	29	25	86.6	2.7	Yes
Male	60	18	30.0	27	23	85.2	2.8	Yes
Statistical analysis p < 0.05			No			No
Age (years)
13-50	57	11	19.3	31	25	80.6	4.2	Yes
> 50	99	38	38.4	25	23	92.0	2.4	Yes
Statistical analysis p < 0.05			Yes			No
Arterial Hypertension
Present	47	20	42.6	11	9	81.8	5.5	Yes
Absent	109	29	26.6	45	39	86.7	3.3	Yes
Statistical analysis p < 0.05			Yes			No
Ventricular extrasystoles
Present	49	20	40.8	32	28	87.5	2.1	Yes
Absent	107	29	27.1	24	20	83.3	3.1	Yes
Statistical analysis p < 0.05			No			No
CBRB + LAH
Present	61	16	26.2	22	20	90.9	3.5	Yes
Absent	95	33	34.7	34	28	82.3	2.4	Yes
Statistical analysis p < 0.05			No			No
Ejection fraction < 45%
Present	9	8	88.9	21	21	100.0	1.1	No
Absent	147	41	27.9	35	27	77.1	2.7	Yes
Statistical analysis p < 0.05			Yes			Yes

G1: patients with cardiopathy without left ventricle aneurysms; G2: patients with cardiopathy and left ventricle aneurysms; *: Epi info 7 (statcalc, non-corrected chi-square); RR: risk ratio; CBRB + LAH: complete blockage of the right branch + left anterior hemiblock.

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Chagas disease in Virgem da Lapa, Minas Gerais, Brazil: left ventricle aneurysm and the risk of death in the 24-year interval

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[1] + Corresponding author: borges@ioc.fiocruz.br - jborgespereira207@gmail.com