Epidemiology of Chagas Disease in Non-Endemic European Countries

Chagas disease results from infection by the protozoan Trypanosoma cruzi and was presviously described as an endemic disease focused in populations living in poor rural areas of Latin American countries. Currently, migrant populations and some modes of transmission such as blood and organ donation or vertical transmission from infected mothers to their children have caused the spread of this disease beyond its natural geographical boundaries. In Europe, Spain, with over half of these migrants, is undoubtedly the most important recipient, followed by Italy, France and United Kingdom. However, in non-endemic countries there is no universal screening systems and also physicians are often poorly trained in recognizing this disease. So far, few countries are aware of the emergence of this disease and only few European countries have established changes in their health system to address this disease. The National European Health authorities should take part to this model-of-care, adapting in this new epidemiological scenario with screening this pathology in blood donors, organ donations or vertically from mother to child at birth. These mechanisms are the main forms of human infestation in nonendemic countries and are, therefore, the major targets for reduction of spread

Predictors of atrial tachyarrhythmias in adults with congenital heart disease

Background: Atrial tachyarrhythmias (ATs) represent the major late complications of congenital heart diseases (CHDs) following surgery. Little is known about the association between echocardiographic parameters and AT. Aims: This study aimed to investigate a potential correlation among clinical, echocardiographic, and electrocardiographic parameters and AT as well as to analyze outcomes in adults with CHD and AT. Methods: A retrospective case‑control study was performed in adults with CHD. We included 71 patients with AT and 71 control individuals matched by sex, age, and the type of CHD without AT, all from the same institute. Medical records, electrocardiograms, and echocardiograms were reviewed. Adverse cardiovascular events were recorded and defined as cardiovascular mortality, admission for heart failure, or stroke. The univariate and multivariate logistic regression analysis of possible risk factors and the Kaplan–Meier analysis of adverse cardiovascular events were performed. Results: Subpulmonary ventricular systolic pressure≥40 mm Hg (hazard ratio [HR], 6.8; 95% CI, 2.4–18; P < 0.001), right atrial dilatation≥21 cm2 (HR, 3.1; 95% CI, 1.2–7.6; P = 0.01), and significant tricuspid regurgitation (HR, 4; 95% CI, 1.3–10; P = 0.02) were identified as the main risk factors for AT. Patients with AT had worse outcomes, more frequently developed adverse cardiovascular events (86% vs 14%; P < 0.01), and exhibited a 58% event‑free survival rate compared with 98% of the patients without AT after 8 years of follow‑up (log rank, 6.6; P = 0.01). Conclusions: Among patients with CHD, the main risk factors for AT include right atrial dilatation, high subpulmonary ventricular systolic pressure, and significant tricuspid regurgitation. The presence of AT may increase the risk of adverse cardiac events

Unusual Heart Involvement of Wegener’s Granulomatosis and Literature Review

A female patient, 60 years of age, was presented to our hospital with chest pain and monomorphic ventricular tachycardia (VT). She was transferred to the Coronary Care Unit and amiodarone perfusion restored basal rhythm in atrial fibrillation. She has not sign of heart failure. A transtoracic echocardiogram (TTE) was performed and an one mitral mass was found at atrioventricular junction with displacement of the posterior mitral leaflet A transesophageal echocardiogram (TEE) demonstrated a mass at atrioventricular junction level with severe mitral regurgitation. Cardiac Magnetic Resonance (CMR) confirmed the mass and anterolateral papillary muscle was thickening and hypertrophied with hyperenhancement consistent with fibrosis. Moreover, T2-weighted imaging demonstrated hyperintense mass with respect to the surrounding myocardium in relation of inflammatory mass. She had saddle nose by destruction of the septum, bilateral hearing loss, sinusitis and scleritis and renal involvement as well. This patient was diagnosed of Wegener's Granulomatosis (WG) and she was treated with methylprednisolone during 3 days, continued with prednisolone and cyclophosphamide. An 8 days later echocardiogram did not find the mass. However, the patient developed symptomatology of heart failure and in the context of severe mitral regurgitation, mitral valve replacement was decided in multi-disciplinary Cardiology-Cardiothoracic meeting.