Avaliação das artérias carótidas de pacientes chagásicos acometidos por eventos isquêmicos cerebrais

Abstract

Introduction: The occurrence of thromboembolic events, particularly of cerebrovascular events, over the course of chronic Chagas cardiopathy represents topic of great clinical importance and scientific interest. Cardioembolic stroke is considered their most important cause. Vascular inflammatory injuries have been shown to be associated with T. cruzi infection in experimental studies. Material and Methods: The present study evaluated carotid arteries in chagasic patients with antecedents of cerebral ischemic events, including the diagnosis and morphologic characterization of atherosclerotic plaques, measure of intima-media thickness and quantitative evaluation of the arterial stiffness. This is a transversal study, carried through between October 2009 and December 2010, including 26 chagasic patients with previous ischemic events and 26 chagasic patients without previous events as a control group. The groups have been matched for age, sex, cardiovascular risk factors and severity of cardiac disfunction. After informed consent, all patients underwent a complete clinical evaluation, analysis of the electrocardiographic registers, neurologic evaluation, echocardiographic study and carotid artery ultrasound. Results: The groups had not differed in demographic characteristics, functional class, presence of cardiac arrhythmias and cardiovascular risk factors. Diastolic blood pressure was higher in patients with events, even though pressoric levels remained within normal limits (77.1 ± 8.6 versus 69.8 ± 10.1 mmHg, p=0.043). Pharmacological treatment only differed in relation to the oral anticoagulants use (more frequent in patient with previous events, 73% versus 19%, p<0.001). The classification of the cerebral ischemic events evidenced predominance of cardioembolic stroke (89%) compromising partially the anterior circulation (70%). The echocardiographic findings had not differed between the groups, with exception to the presence of apical aneurism (more frequent in patient with previous events, 85% versus 19%, p<0.001), and intracardiac thrombus (more frequent in patient with previous events, 31% versus 0%, p=0.002). Local systolic and diastolic blood pressures calculated from the exploration of right and left common carotid arteries had differed between the two groups, being higher in patients with ischemic cerebrovascular events. Conclusions: The present study has demonstrated association between elastic properties of the carotid artery wall and previous occurrence of cerebrovascular ischemic events in patients with chronic Chagas cardiopathy. Arterial stiffness, evaluated through local arterial pressures, was greater in patients with cerebrovascular events than in controls with similar demographic and clinical characteristics. Prevalence of atherosclerotic plaques and the carotid intima media-thickness had not differed between the two groups