Doença de Chagas: um fator de risco independente para acidente vascular cerebral isquêmico

Abstract

Chagasic cardiomyopathy seems to be associated with cerebrovascular events. We sought to evaluate Chagass disease (CD) prevalence among patients admitted with ischemic stroke, investigating if positive serology for CD is really an independent risk factor this condition. We did a case-control study with 101 consecutive stroke patientsand 100 consecutive acute coronary syndrome (ACS) admitted in an emergence hospital. All patients have been screened for CD serology, confirmed when both immunofluorescence and hemagglutination tests were positive. Data collected included age, sex, cardiocerebrovascular risk factors, diagnostic stroke subtype (TOAST and Bamford classifications), electrocardiogram studies and, whenever possible,echocardiography findings. Age (p=0.006), female gender (p=0.011), systolic blood pressure (p=0.001), diastolic blood pressure (p=0.034), stroke/TIA history (p <0.001), atrial fibrillation (p=0.005), others arrhythmias (p=0.05) and CD positive serology (p=0.002) were more frequent among stroke patients than ACS patients. After multivariate analysis, stroke/TIA history (p <0,001, OR 6,982 [IC 95% .2.993 to 16.291]), atrial fibrillation (p=0.005, OR 4,518 [IC 95% 1.454 to 14.039]) and CD positive serology (p=0.013, OR 7.171 [C 95% 1.504 to 34.189]) remained independently associated with stroke. Sixty four percent of the CD stroke patients were classified as cardioembolic (TOAST) against 29% of the non-CD patients (p=0.009, OR de 4,464 [IC 95% 1.361 -14.640]). We conclude that CD is an independent risk factor for ischemic stroke probably by cardioembolic mechanisms.