IJCS | Volume 31, Nº2, March / April 2018

DOI: 10.5935/2359-4802.20180011 Abstract Chronic Chagas disease cardiomyopathy ( CCC ) is a result of low-intensity, but incessant, focal fibrosingmyocarditis, caused by persistent T. cruzi infection associated with inflammation, mediated by adverse immunemechanisms. About 30 percent of infected individuals have developed throughout life the chronic cardiac formof Chagas' disease with protean clinical manifestations, such as sudden death, signs and symptoms of heart failure, cardioembolic events, arrhythmia and angioid symptoms. Sudden death and the progression of heart failure (HF) are the most common mechanisms of death in this condition. The most relevant prognostic aspects are symptoms of advancedHF (NYHA Fc III-IV), cardiomegaly, LV systolic dysfunction and nonsustained ventricular tachycardia. Preventing cardioembolic events is an important aspect in the management of patients with CCC. Oral anticoagulant agentsmust beprescribed for high-riskpatients according to the presence of a set of risk factors: LV systolic dysfunction, apical aneurysm, alteredventricular repolarizationbyECG and advanced age. The treatment of HF in patients with CCC follows the same principles applied to HF secondary to dilated cardiomyopathy of other etiologies. Introduction Chagas disease (ChD) is caused by the protozoan parasite Trypanosoma cruzi, which causes an acute myocarditis and subsequently a low-grade incessant chronic fibrosing myocarditis, which produces progressive myocardial damage and later results in chronic cardiomyopathy of chronic Chagas' disease (CCC). Cardiac impairment in patients in the chronic phase of thedisease includes relevant morbidityandmortality, inaddition tobeing themaincause of nonischemic cardiomyopathy in Latin America. Epidemiology Chagas Disease transmission cycle has been based mostly on triatomine species as main vectors of the disease . However, after several national campaigns and multinational initiatives, transmission by this means is partially controlled. In 2006, Brazil was certified by the WorldHealthOrganization (WHO) as an area free of ChD vectorial transmission by the most important domiciled vector, the Triatoma infestans. 1,2 This in no way represents the disease eradication– an inherently unreachable goal – which continues to occur, through outbreaks mediated by other transmissionmechanisms, such as the oral route. From 1975 to 1995, the Southern Cone Initiative against Chagas' disease detected an 89% reduction in the disease transmission. 3 Mortality rates secondary toChagas' disease have also been reduced to 75% since the 1990’s. 4 However, WHO still estimates that 300,000 new cases of the disease are diagnosed each year in Latin America and believes that there are 8 million infected people worldwide. CCC is considered a major public health problem in the endemic areas of Latin America, and represents one of the greatest causes of heart failure and sudden death. Nowadays, due to globalization and migratory currents, it is also an emergent disease in nonendemic countries, such as the United States of America, Canada, Spain, France, Switzerland, Italy, Japan, and other countries in Asia and Oceania. 1,5,6 National history and evolutive stages The natural history of ChD includes acute and chronic phases. Most patients with the acute disease are 173 REVIEW ARTICLE International Journal of Cardiovascular Sciences. 2018;31(2)173-189 Mailing Address: Prof. Dr. Marcus Vinícius Simões, MD, PhD Cardiology Division – Internal Medicine Department Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, 3900 Bandeirantes Avenue, Ribeirão Preto, SP – Brazil e-mail: msimoes@fmrp.usp.br Chagas Disease Cardiomyopathy MarcusVinicius Simões, MinnaMoreira Dias Romano, André Schmidt, Káryta SuelyMacedoMartins, José Antonio Marin-Neto Divisão de Cardiologia - Departamento de Clínica Médica - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, SP – Brazil Manuscript received September 08, 2017, revised manuscript October 27, 2017, accepted November 13, 2017 Cardiomyopathies; Chagas Cardiomyopathy; Trypanosoma Cruzi; Chagas Disease; Heart Failure. Keywords