• A L Basquiera, A Sembaj, A M Aguerri, M Omelianiuk, S Guzmán, J Moreno Barral, T F Caeiro, R J Madoery, and O A Salomone.
• Internal Medicine Training Programme, Department of Education, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina. anabasquiera@arnet.com.ar
• Heart. 2003 Oct 1; 89 (10): 1186-90.

BackgroundPolymerase chain reaction (PCR) allows detection of Trypanosoma cruzi in blood throughout the course of Chagas' disease.ObjectiveTo determine whether T cruzi DNA detected by PCR is associated with progression to chronic Chagas cardiomyopathy.DesignProspective cohort study.SettingA tertiary care centre in Argentina.Patients56 consecutive patients with chronic T cruzi infection.MethodsClinical examination, ECG, and Doppler echocardiography were carried out at baseline and at the end of the follow up. Detection of T cruzi DNA by PCR amplifying a nuclear sequence was undertaken in all patients at baseline.Main Outcome MeasuresProgression was defined as death from chronic cardiomyopathy or the presence of a new ECG or left ventricular echocardiographic abnormality at the end of follow up.ResultsThe 56 patients (21 male, 35 female; mean (SD) age, 56.0 (11.3) years) were followed for a mean 936.3 (244.39) days. Progression to cardiomyopathy was detected in 12 patients (21.4%). Three of these patients died after baseline evaluation. Univariate analysis showed that a positive PCR (relative risk 4.09, 95% confidence interval (CI) 1.60 to 9.85) and male sex (5.00, 95% CI 1.65 to 15.73) were associated with progression. Multivariable logistic regression indicated that both sex and PCR were independent variables affecting the outcome.ConclusionsIn a cohort of seropositive individuals, patients with T cruzi DNA detected by PCR and male patients were at higher risk of progression. These results highlight the importance of T cruzi in the pathophysiology of chronic cardiomyopathy.

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