P5412Prevalence of ischemic stroke in patients with chagas disease using cardiac implantable electronic devices

Abstract

Background: It is known that Chagas Disease (DC) is related to Ischemic stroke. However, studies describing the occurrence of ischemic stroke in patients with Chagas Disease using cardiac implantable electronic devices (CIEDs) have not been described in the literature, in the absence of triggers for cardioembolic mechanisms, such as supraventricular arrhythmias (atrial fibrillation (AF) / atrial flutter). Objective: To describe the prevalence of Ischemic stroke in patients with CD and CIEDs. Methods: A prospective, cross-sectional study conducted in an Arrhythmia Outpatient Clinic of a Cardiology Hospital, between May 2016 and February 2017. 60 patients participated in the study, and the exclusion criteria were the presence of AF / atrial flutter and the use of oral anticoagulants. All patients underwent electrocardiogram and cranial tomography (CT). Results: A total of 19 cases (32%) of Ischemic stroke were evidenced by CT. Of these patients, 63.2% were female, 68.4% were aged ≥60 years and 84.3% were of black ethnicity. Comorbidities included hypertension (78.9%), followed by dyslipidemia (42.1%) and diabetes mellitus (10.5%). Regarding the clinical form of CD, 94.7% had Cardiac (Chronic Chagasic Cardiopathy - CCC) and 5.3% Cardiodigestive form (Chagasic Megaesophagus). Among the clinical manifestations of CCC, 100% had arrhythmic syndrome and 47.4% had heart failure. Regarding the left ventricular ejection fraction (LVEF - Simpson), 87.5% had LVEF>40%. The three types of CIEDs were present, but the majority (84.2%) used pacemakers. The average time for implantation of the CIEDs was 6.2±4.9 years and the main indication for the implant was second degree Atriventricular Block or Third degree Atrioventricular Block (63.2%). It was evidenced on the electrocardiogram of these patients that 57.9% presented pacemaker rhythm, 21.1% sinus rhythm, 15.8% sinus and pacemaker rhythm and 5.3% were in Third degree Atrioventricular Block rhythm. Regarding drugs, 52.6% used diuretics, 47.4% beta-blockers, 15.8% antiarrhythmic drugs, 31.6% used statins and 21.1% antiplatelet agents. It was evidenced that 89.5% of patients with Ischemic stroke on CT, had no prior stroke history (odds ratio: 3.41; 95% confidence interval [CI]: 2.29-5.1; P=0.03). Conclusion: There was a high prevalence of Ischemic stroke in the study population, where most patients were unaware of this information. The occurrence of this event in this profile of patients still requires further investigation, thus a careful evaluation becomes essential for better outpatient management and therapeutic decisions for this population.