Mechanisms Responsible for Myocardial Damage Progression in Chronic Chagas Disease

Autor: Diego F. Dávila-Spinetti, Liliana Lobo-Vielma, Humberto J. Colmenarez-Mendoza
Rok vydání: 2005
Předmět:
Zdroj: Revista Española de Cardiología (English Edition). 58:1007-1009
ISSN: 1885-5857
DOI: 10.1016/s1885-5857(06)60431-3
Popis: Rev Esp Cardiol. 2005;58(9):1007-9 1007 The mechanisms leading to the progression of chronic Chagas heart disease are still unknown. The hypotheses proposed for explaining the pathogenesis of this endemic disease include the persistence of the parasite in the hearts of infected patients,1 the development of an autoimmune response,2 and cardiotoxicity caused by catecholamines.3 Recent studies have consistently and unequivocally shown the persistence of the parasite in the blood and myocardial tissue of patients with chronic Chagas disease. This is true of patients in the indeterminate, arrhythmic and congestive stages.1 However, the survival of these patients does not appear to be determined exclusively by the presence of the parasite. Patients from different South American countries (in non-endemic zones) who were serologically positive for Trypanosoma cruzi and active infection but who had normal left ventricular cineangiography showed 100% survival at 16 years of follow-up.4 However, the presence of segmental myocardial damage (apical aneurysm) or left ventricular systolic dysfunction was accompanied by a mortality of nearly 60% at four years of follow-up (Figure).5 A number of clinical studies have investigated whether eradication of the parasite with specific treatment modifies the course of chronic Chagas disease, but while the results have been mildly encouraging they have also been somewhat contradictory.6 Over the last 10 years, a number of randomized, double-blind trials have been undertaken to investigate the effects of benznidazole in patients with indeterminate and chronic disease. Follow-up was for 3-4 years. The aims of these studies were related to the reduction of the parasitic load (conversion to seronegativity or a ED I TO R I A L S
Databáze: OpenAIRE
Externí odkaz: