Anatomopathological Consequences of the Change in the Clinical-Demographic Profile of Chagasic Patients Who Are Candidates for Heart Transplantation in Recent Years

Purpose Chagasic cardiomyopathy is considered the most aggressive etiology of heart failure (HF). As there is no etiological treatment capable of reversing the evolution of the disease, cardiac replacement therapy such as heart transplantation (HT) may be needed. In recent years, changes in the clinical and demographical profiles of chagasic patients who are candidates for HT have been noticed. This study aims to evaluate the histopathological implications of the change in the clinical-demographic profile of chagasic patients in recent years. Methods This is a retrospective observational study in which 313 chagasic patients undergoing HT from 1/1/2010 to 12/31/2019 were included and divided into 2 groups according to the time when HT was performed: a) HT until 12/31/2016; b) HT from 12/1/2017 to 12/31/2019. The pathological characteristics of all 313 explanted hearts were evaluated. Furthermore, they were correlated with laboratory diagnoses of Chagas disease performed in all patients. Results In a previous study, we demonstrated a change in the clinical-demographic profile of chagasic patients who are candidates for HT in recent years. When evaluating the pathological diagnoses of the explanted hearts, of the 289 patients in group A, 285 (98.6%) were in agreement with the laboratory diagnosis of Chagas disease, but in group B, of the 24 patients, 16 (66.7%) did not agree between the laboratory diagnosis of Chagas disease and the anatomopathological diagnosis. Of these 24 patients, 7 (29.1%) had histopathological features suggestive of ischemic cardiomyopathy, 9 (37.5%) had histopathological features of nonspecific dilated cardiomyopathy and only 8 (33.4%) patients had agreement between laboratory and histopathological diagnosis of Chagas disease. Conclusion In addition to older age and more comorbidities, another objective finding corroborates the change in the clinical-demographic profile of chagasic patients who are candidates for heart transplantation is the significant disagreement between laboratory and anatomopathological diagnoses, making it challenging to confirm the etiological diagnosis of HF in patients with a serological diagnosis of Chagas disease. Chagasic cardiomyopathy is considered the most aggressive etiology of heart failure (HF). As there is no etiological treatment capable of reversing the evolution of the disease, cardiac replacement therapy such as heart transplantation (HT) may be needed. In recent years, changes in the clinical and demographical profiles of chagasic patients who are candidates for HT have been noticed. This study aims to evaluate the histopathological implications of the change in the clinical-demographic profile of chagasic patients in recent years. This is a retrospective observational study in which 313 chagasic patients undergoing HT from 1/1/2010 to 12/31/2019 were included and divided into 2 groups according to the time when HT was performed: a) HT until 12/31/2016; b) HT from 12/1/2017 to 12/31/2019. The pathological characteristics of all 313 explanted hearts were evaluated. Furthermore, they were correlated with laboratory diagnoses of Chagas disease performed in all patients. In a previous study, we demonstrated a change in the clinical-demographic profile of chagasic patients who are candidates for HT in recent years. When evaluating the pathological diagnoses of the explanted hearts, of the 289 patients in group A, 285 (98.6%) were in agreement with the laboratory diagnosis of Chagas disease, but in group B, of the 24 patients, 16 (66.7%) did not agree between the laboratory diagnosis of Chagas disease and the anatomopathological diagnosis. Of these 24 patients, 7 (29.1%) had histopathological features suggestive of ischemic cardiomyopathy, 9 (37.5%) had histopathological features of nonspecific dilated cardiomyopathy and only 8 (33.4%) patients had agreement between laboratory and histopathological diagnosis of Chagas disease. In addition to older age and more comorbidities, another objective finding corroborates the change in the clinical-demographic profile of chagasic patients who are candidates for heart transplantation is the significant disagreement between laboratory and anatomopathological diagnoses, making it challenging to confirm the etiological diagnosis of HF in patients with a serological diagnosis of Chagas disease.