Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy

• Autor(a) principal: Marin-Neto, José Antonio
• Data de Publicação: 2022
• Outros Autores: Rassi Jr., Anis, Moraes Oliveira, Gláucia M., Lemos Correia, Luís Claudio, Novaes Ramos Jr., Alberto, Hasslocher-Moreno, Alejandro Marcel, Luquetti Ostermayer, Alejandro, Sousa, Andréa Silvestre de, Amato Vincenzo de Paola, Angelo, Sobral de Sousa, Antonio Carlos, Pinho Ribeiro, Antonio Luiz, Correia Filho, Dalmo, Moraes de Souza, Dilma do Socorro, Cunha-Neto, Edecio, J. A. Ramires, Felix, Bacal, Fernando, Pereira Nunes, Maria do Carmo, Martinelli Filho, Martino, Ibrahim Scanavacca, Maurício, Magalhães Saraiva, Roberto, Alves de Oliveira Júnior, Wilson, M. Lorga-Filho, Adalberto, de Jesus Benevides de Almeida Guimarães, Adriana, Lopes Latado Braga, Adriana, Sarmento de Oliveira, Adriana, V. L. Sarabanda, Alvaro, Yecê das Neves Pinto, Ana, Assis Lopes do Carmo, André, Schmidt, André, Costa, Andréa Rodrigues da, Ianni, Barbara Maria, Markman Filho, Brivaldo, Eduardo Rochitte, Carlos, Thé Macedo, Carolina, Mady, Charles, Chevillard, Christophe, Bittencourt das Virgens, Cláudio Marcelo, Nery de Castro, Cleudson, De Paoli de Carvalho Britto, Constança Felícia, Pisani, Cristiano, do Carmo Rassi, Daniela, C. Sobral Filho, Dario, Rodrigues Almeida, Dirceu, A. Bocchi, Edimar, T. Mesquita, Evandro, de Souza Nogueira Sardinha Mendes, Fernanda, Pereira, Francisca Tatiana, Sperandio da Silva, Gilberto Marcelo, de Lima Peixoto, Giselle, Glotz de Lima, Gustavo, H. Veloso, Henrique, Turin Moreira, Henrique, Bellotti Lopes, Hugo, Masciarelli Francisco Pinto, Ibraim, Pinto Dias, João Carlos, Bemfica, João Marcos, Silva-Nunes, João Paulo, Soares Barreto-Filho, José Augusto, Kerr Saraiva, José Francisco, Lannes-Vieira, Joseli, Menezes Oliveira, Joselina Luzia, V. Armaganijan, Luciana, Martins, Luiz Cláudio, C. Sangenis, Luiz Henrique, Barbosa, Marco Paulo, Almeida-Santos, Marcos Antônio, Simões, Marcos Vinicius, Shikanai-Yasuda, Maria Aparecida, Vieira Moreira, Maria da Consolação, Higuchi, Maria de Lourdes, Costa Monteiro, Maria Rita de Cássia, Felix Mediano, Mauro Felippe, Maia Lima, Mayara, T. Oliveira, Maykon, Moreira Dias Romano , Minna, Nitz, Nadjar, de Tarso Jorge Medeiros, Paulo, Vieira Alves, Renato, Alkmim Teixeira, Ricardo, Coury Pedrosa, Roberto, Aras, Roque, Morais Torres, Rosália, dos Santos Povoa, Rui Manoel, Rassi, Sérgio Gabriel, Salles Xavier, Sérgio, Marinho Martins Alves , Silvia, B. N. Tavares, Suelene, Lima Palmeira, Swamy, da Silva Junior, Telêmaco Luiz, da Rocha Rodrigues, Thiago, Madrini Junior, Vagner, Maia da Costa , Veruska, Dutra, Walderez
• Tipo de documento: preprint
• Idioma: por
• Título da fonte: SciELO Preprints
• Texto Completo: https://preprints.scielo.org/index.php/scielo/preprint/view/4820
• topic: Cardiomiopatia da Doença de Chagas; Forma Indeterminada da Doença de Chagas; Transmissão Oral; T. cruzi; Estratificação de Risco; Tratamento Tripanossomicida; Insuficiência Cardíaca; Arritmias; Tromboembolismo; Transplantes cardíacos; Cardiomyopathy of Chagas disease; Indeterminate form of Chagas disease; Oral Transmission; T. cruzi; Risk Stratification; Trypanosytreatment; Heart failure; Arrhythmias; Thromboembolism; Heart transplants

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.