Chagas cardiomyopathy is associated with higher incidence of stroke: A meta-analysis of observational studies

Rhanderson N. Cardoso, Francisco Yuri B. Macedo, Melissa Nolan Garcia, Daniel C. Garcia, Alexandre M. Benjo, David Aguilar, Hani Jneid, Biykem Bozkurt

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Background Chagas disease (CD) has been associated with an elevated risk of stroke, but current data are conflicting and prospective controlled studies are lacking. We performed a systematic review and meta-analysis examining the association between stroke and CD.

Methods Pubmed, Embase, Cochrane Central, Latin American database, and unpublished data were searched with the use of the following terms: ("Chagas" OR "American trypanosomiasis") AND ("dilated" OR "ischemic" OR "idiopathic" OR "nonChagasic" OR "stroke" OR "cerebrovascular"). We included studies that reported prevalence or incidence of stroke in a CD group compared with a non-CD control group. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model.

Results A total of 8 studies and 4,158 patients were included, of whom 1,528 (36.7%) had CD. Risk of stroke was elevated in the group of patients with CD (OR 2.10, 95% CI 1.17-3.78). Similar results were observed in a subanalysis of cardiomyopathy patients (OR 1.74, 95% CI 1.02-3.00) and in sensitivity analysis with removal of each individual study. Furthermore, exclusion of studies at higher risk for bias also yielded consistent results (OR 1.70, 95% CI 1.06-2.71). Subanalysis restricted to studies that included patients with the indeterminate form found no significant difference in the stroke prevalence between CD and non-CD patients (OR 3.10, 95% CI 0.89-10.77).

Conclusions CD is significantly associated with cerebrovascular events, particularly among patients with cardiomyopathy. These findings underline the need for prospective controlled studies in patients with Chagas cardiomyopathy to ascertain the prognostic significance of cerebrovascular events and to evaluate the role of therapeutic anticoagulation in primary prevention.

Original languageEnglish
Pages (from-to)931-938
Number of pages8
JournalJournal of Cardiac Failure
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2014

Keywords

  • Chagas cardiomyopathy
  • meta-analysis
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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