Introduction: Chagas disease is a major cause of cardiomyopathy and cardioembolic stroke in Latin America. However, stroke has been reported in patients without cardiomyopathy.
Hypothesis: We aimed to determine if Chagas is associated with combined events of stroke or death.
Methods: Open hospital-based cohort of consecutive stroke-free individuals with suspected heart failure or asymptomatic Chagas (positive serologic test only) followed from February, 2002 to July, 2015. Endpoint was combined events of stroke or death. Potential confounders included age, sex, cerebrovascular risk factors, echocardiographic left ventricular ejection fraction and EKG rhythm, adjusted in a multivariable Cox regression.
Results: Participants were 556 individuals, mean age 55 (+/- 12) years, followed for a mean of 2.3 (+/- 1.5) years, leading to 1297 person-years of observation. Chagas was present in 288 (52%) and cardiomyopathy in 444 (80%) individuals at baseline. There were 2.2 strokes and 8.4 stroke or death events per 100 person-years among patients with Chagas, when compared to 1.3 strokes and 6.5 stroke or death events per 100 person-years among non-chagasic patients. In the model adjusted for potential confounders, Chagas remained an independent predictor of stroke or death (hazard ratio = 2.52; 95% confidence interval = 1.29 - 4.95, p=0.007).
Conclusions: Chagas disease is associated a 2.5-fold increase in the rate of early stroke or death independently of cardiac disease. Non-cardioembolic mechanisms for stroke should be further investigated in this population.