Chronic Chagas cardiopathy (CCC) is a potentially lethal condition, but the severity of the disease varies widely and accurate stratification of the risk of disease progression and death remains an unsolved challenge. Although complex prognostic scores are available, a simple, low-cost and easy-to-use prognostic model, suitable for the primary care setting, is lacking. The first hypothesis of this project is that a prognostic algorithm based on simple ECG measurements in conjunction with clinical information and Brain Natriuretic Peptide (BNP) levels can be developed that will accurately predict the risk of disease progression and death in CCC patients and be useful in clinical practice. The goal is therefore to develop and test a simple predictive algorithm for determining the prognosis of patients with CCC. To accomplish this goal, a large cohort of infected patients will be established based on the Telehealth Program designed to support primary care in Minas Gerais. We will enroll 2,000 CCC patients into this cohort study and follow them for at least two years, in order to develop and validate this simple prognostic algorithm. However we recognize that CCC has a complex physiopathology and many immunological, inflammatory, neural and microvascular processes have a role in development of CCC and progression of disease. The second hypothesis to be tested here is that hitherto unknown or untested biomarkers will be useful in the management of Chagas disease patients. The identification of new biomarkers through the other projects in the SAMI-Trop program should enable refined stratification of T cruzi infected patients with respect to occurrence of specific complications and death and in the guidance of treatment of CCC patients. Consequently, the second goal of this study is to collect blood specimens to establish a robust sample repository for testing of new biomarkers detected in the other branches of this project. The prognostic importance of these biomarkers will be tested using a nested case-control design

Public Health Relevance

Chronic Chagas cardiomyopathy (CCC) is the most important clinical presentation of Chagas disease. A simple prognostic algorithm will help primary care physicians manage and care for CCC patients. New biomarkers will also be evaluated for refined stratification of T cruzi infected patients for use in prognosis and guidance of treatment of CCC patients

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Specialized Center (P50)
Project #
5P50AI098461-03
Application #
8707362
Study Section
Special Emphasis Panel (ZAI1)
Project Start
Project End
Budget Start
2014-08-01
Budget End
2015-07-31
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Fundacao Faculdade de Medicina
Department
Type
DUNS #
City
Sao Paulo
State
Country
Brazil
Zip Code
05401-000
Cardoso, Clareci Silva; Sabino, Ester Cerdeira; Oliveira, Claudia Di Lorenzo et al. (2016) Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile. BMJ Open 6:e011181
Keating, S M; Deng, X; Fernandes, F et al. (2015) Inflammatory and cardiac biomarkers are differentially expressed in clinical stages of Chagas disease. Int J Cardiol 199:451-9
Navarro, Isabela Cunha; Ferreira, Frederico Moraes; Nakaya, Helder I et al. (2015) MicroRNA Transcriptome Profiling in Heart of Trypanosoma cruzi-Infected Mice: Parasitological and Cardiological Outcomes. PLoS Negl Trop Dis 9:e0003828
Carmo, Andre A L; Rocha, Manoel O C; Silva, Jose L P et al. (2015) Amiodarone and Trypanosoma cruzi parasitemia in patients with Chagas disease. Int J Cardiol 189:182-4
Tanowitz, Herbert B; Machado, Fabiana S; Spray, David C et al. (2015) Developments in the management of Chagas cardiomyopathy. Expert Rev Cardiovasc Ther 13:1393-409
Abel, Lúcia Cristina Jamli; Ferreira, Ludmila Rodrigues Pinto; Cunha Navarro, Isabela et al. (2014) Induction of IL-12 production in human peripheral monocytes by Trypanosoma cruzi Is mediated by glycosylphosphatidylinositol-anchored mucin-like glycoproteins and potentiated by IFN- γ and CD40-CD40L interactions. Mediators Inflamm 2014:345659
Capuani, Ligia; Bierrenbach, Ana Luiza; Abreu, Fatima et al. (2014) Accuracy of a probabilistic record-linkage methodology used to track blood donors in the Mortality Information System database. Cad Saude Publica 30:1623-32