Antunes, A

Busch, MP

Capuani, L

Carrick, D

Custer, B

De Almeida Neto, C

Di Lorenzo Oliveira, C

Fernandez, F

Ianni, B

Menezes, M

Murphy, EL

Nastari, L

Patavino, G

Ribeiro, A

Sabino, E

Sachdev, V

Salemi, V

Wright, D

eScholarship - University of California

UCSFUC San Francisco Previously Published WorksTitleTEN-YEAR INCIDENCE OF CHAGAS CARDIOMYOPATHY AMONG ASYMPTOMATIC T. CRUZI SEROPOSITIVE, FORMER BLOOD DONORSPermalinkhttps://escholarship.org/uc/item/2qp392cjAuthorsMurphy, ELSabino, ERibeiro, Aet al.Publication Date2012 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaSubmittedon April 30, 03:10 PMfor aabb2012ProofCONTROL ID: 1400776TITLE: Incidence Of Chagas Cardiomyopathy And Relative Diagnostic Value Of Electrocardiogram (ECG)Versus Echocardiogram (ECHO) Among T. Cruzi Seropositive DonorsAUTHORS (LAST NAME, FIRST NAME): Sabino, Ester C.7, 2; Ribeiro, Antonio4; Patavino, G. M.7; Capuani,Ligia D.2; de Almeida Neto, Cesar2; Di Lorenzo Oliveira, Claudia3; Carrick, Danielle M.5; Custer, Brian6, 1;Busch, Michael P.6, 1; Murphy, Edward L.1, 6INSTITUTIONS (ALL): 1. University of California San Francisco, San Francisco, CA, United States.2. Fundacao Pro-Sangue - Hemocentro de Sao Paulo, Sao Paulo, Brazil.3. Fundacao Hemominas, Belo Horizonte, Brazil.4. Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.5. Westat, Inc., Rockville, MD, United States.6. Blood Systems Research Institute, San Francisco, CA, United States.7. Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.PRESENTATION TYPE: Oral or Poster PresentationCURRENT CATEGORY: ScientificCURRENT SUB-CATEGORY: Transfusion-Transmitted Infectious Diseases II: Bacteria, Parasites, PrionsABSTRACT BODY:Background/Case Studies: Few studies have prospectively evaluated the natural history of Chagascardiomyopathy, including disease penetrance, prognostic factors and indications for treatment. Nor has thediagnostic utility of ECHO been compared to the simpler and less costly ECG screening.Study Design/Methods: In a retrospective cohort study, T. cruzi seropositive blood donors with an indexblood donation in 1996-2002 in Sao Paulo and Montes Claros, Brazil were matched to seronegative donorson index donation date, age, gender and city. 101 Chagas cardiomyopathy patients served as positivecontrols. In 2009-2010, all subjects underwent a health history questionnaire, medical examination,standardized ECG and ECHO. Subjects with abnormal screening EKG or ECHO were referred to a blindedpanel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Diagnostic sensitivity,specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated separately forECHO and ECG.Results/Findings: Mean follow-up time was 10.5 years for the seropositives and 11.1 years for theseronegatives. The sensitivity of the combined ECHO/ECG and expert panel algorithm was 98%, based ondiagnoses of cardiomyopathy in 99 of 101 previously diagnosed Chagas cardiomyopathy patients, of whom 1(1%) expert referral was triggered by ECHO alone, none by ECG alone and 98 (99%) by both ECHO andECG. In contrast, 24 (5%) of 488 T. cruzi seronegative control donors were falsely classified as havingChagas cardiomyopathy (specificity = 95%). Among the 499 T. cruzi seropositives, 315 (63%) were referred tothe expert panel and 120 (24%) had definite Chagas-like cardiomyopathy, leading to an incidence differenceof 1.85 per 100 person-years attributable to T. cruzi infection. The Table summarizes the sensitivity, specificityand predictive values of ECHO and ECG screening for cardiomyopathy diagnosis among the T. cruziseropositive individuals.Conclusion: There is a substantial (~2%) annual incidence of Chagas cardiomyopathy among initiallyasymptomatic T. cruzi seropositive blood donors. Among seropositives, ECG had better sensitivity and ECHOhad better specificity. Both tests had poor positive predictive value, but ECG had better negative predictivevalue. Future studies could use a two-step algorithm in which ECG is used to exclude those with a negativeAbstract Central - Abstract Proof PopUp http://aabb2012.abstractcentral.com/abstract?TAG_ACTION=VIEW_...1 of 2 4/30/2012 12:10 PMtest and low likelihood of disease. ECHO would be done to refine the diagnosis only in patients with abnormalECG findings.Expert Panel Diagnosis of Cardiomyopathy in T. cruzi seropositivesECHO YES (N=120) NO N=(379)  Triggered by ECHO 75 77 PPV=49%Not Triggered by ECHO 45 302 NPV=87% Sens=63% Spec=80%  ECG    Triggered by ECG 114 151 PPV=43%Not Triggered by ECG 6 228 NPV=97% Sens=95% Spec=60%  (No Image Selected)Study Name: REDS-II Brazil international componentScholarOne Abstracts® (patent #7,257,767 and #7,263,655). © ScholarOne, Inc., 2012. All Rights Reserved.ScholarOne Abstracts and ScholarOne are registered trademarks of ScholarOne, Inc. Follow ScholarOne on TwitterTerms and Conditions of UseProduct version number 3.14.2 (Build 23)Build date Apr 25, 2012 12:14:37. Server tss1be0013Abstract Central - Abstract Proof PopUp http://aabb2012.abstractcentral.com/abstract?TAG_ACTION=VIEW_...2 of 2 4/30/2012 12:10 PM

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TEN-YEAR INCIDENCE OF CHAGAS CARDIOMYOPATHY AMONG ASYMPTOMATIC T. CRUZI SEROPOSITIVE, FORMER BLOOD DONORS

TEN-YEAR INCIDENCE OF CHAGAS CARDIOMYOPATHY AMONG ASYMPTOMATIC T. CRUZI SEROPOSITIVE, FORMER BLOOD DONORS

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