Arq. Bras. Cardiol. 2018; 110(2): 111-112
The Indeterminate Form of Chagas Disease
DOI: 10.5935/abc.20180027
This Short Editorial is referred by the Research article "The Presence and Extension of Myocardial Fibrosis in the Undetermined Form of Chagas’ Disease: A Study Using Magnetic Resonance".
The presence of diffuse fibrosis in the myocardial tissue is a characteristic of Chagas heart disease. The mechanisms proposed to explain such fibrosis areas vary and include direct injury by Trypanosoma cruzi to the cardiac tissue, as well as tissue ischemia due to microcirculation changes and microvascular thrombosis mediated by inflammatory and immune processes. The myocardial fibrosis not only reveals important aspects of the pathophysiology of the disease, but has a clinical significance, because its progression can lead to injury to the heart conduction system, contributing to generate arrhythmia, as well as systolic and diastolic ventricular dysfunction, in addition to favoring the appearance of thromboembolic phenomena from the hypokinetic or akinetic areas.
This issue of the Arquivos Brasileiros de Cardiologia presents the results of a study jointly conducted by three different centers in the city of Salvador, Bahia state, about the clinical significance of the fibrosis found in patients with Chagas disease, in both the indeterminate and heart disease (with and without left ventricular dysfunction) stages. The search for fibrosis was performed by use of late enhancement cardiac magnetic resonance imaging. The authors have reported late enhancement compatible with fibrosis in 41% of the patients with the indeterminate form, a figure similar to that found in patients with heart disease without ventricular dysfunction. In addition, it is worth noting the similar findings in the other groups regarding the clinical characteristics and the levels of type B natriuretic peptide, troponin, interleukins 2, 4, 6 and 10, tumor necrosis factor alpha and gamma interferon.
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