Resumo

NOVOA-MONTERO, D.. Rural endemic chronic cardiopathy or common cardiopathy among chagasic and non chagasic people?. Rev. Soc. Ven. Microbiol. [online]. 2002, vol.22, n.2, pp.188-198. ISSN 1315-2556.

Abstract This paper concatenates evidences from three groups of scientific researches, which empower us to have a new outlook on the pathogenesis and to envisage a better prognosis of the chronic cardiac damage associated to many chronic Chagasic patients. Since C. Chagas described (1909) the 'nova entidade mórbida do homem', a chronic clinically malignant myocardiopathy in South America has been linked to Chagas' disease. Evidences coming from several Venezuelan pathologists, who found an 'independent pathology' (Jaffé, Brass, Doehnert, Motta, Souerteig, Salfelder 1937-1985) and a group of cardiologists (Dávila, Donís, Fuenmayor, Torres, Gottberg. 1989-2002) are concordant with a multidisciplinary group of researchers at LabMICE (Novoa-Montero, Torres, Ross, Szklo, 1982-1996) based on two prevalence surveys, incidence and survival studies among rural Venezuelan adults. Altogether, this batch of studies showed similar frequency of autonomic cardiac damage among chronic chagasic or non chagasic adults. Summary findings are: (1) Chronic rural cardiopathy is not associated to Chagas infection but rather to chewing tobacco, males, hypertension, increased body mass index, increased education level, and living alone. A chronic endemic not-yet-defined rural cardiopathy is prevalent; (2) cardiac damage by parasite itself depends on the acute phase of T. cruzi infection. However, its direct contribution to the progression of chronic myocardial damage, would be limited. Dávila et al propose a modified neurogenic hypothesis to unify cardiac remodeling and sympathetic activation to explain this part of the natural history of Chagas' disease; (3) clinical prognosis and treatment of the chronic cardiopathy, contrary of generally believed, is similar for chagasic and non-chagasic adults

Palavras-chave : Infección chagásica; miocarditis chagásica; cardiopatía crónica endémica rural venezolana; epidemiología.