Browsing by Autor "Marcus, Rachel"

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Early identification of patients with Chagas disease at risk of developing cardiomyopathy using 2-D speckle tracking strain: Win, Miranda prediction of Chagas cardiomyopathy
(IJC Heart & Vasculature, 2025) Win, Sithu; Miranda-Schaeubinger, Monica; Durán Saucedo, Ronald Gustavo; Carballo Jimenez, Paula; Flores, Jorge; Mercado Saavedra, Brandon; Camila Telleria, Lola; Raafs, Anne; Verastegui, Manuela; Bern, Caryn; Tinajeros, Freddy; Heymans, Stephane; Marcus, Rachel; Gilman, Robert H.; Mukherjee, Monica
DOI: 10.1016/j.ijcha.2022.101060 | Background: Chagas disease is an endemic protozoan disease with high prevalence in Latin America. Of those infected, 20–30% will develop chronic Chagas cardiomyopathy (CCC) however, prediction using existing clinical criteria remains poor. In this study, we investigated the utility of left ventricular (LV) echocardiographic speckle-tracking global longitudinal strain (GLS) for early detection of CCC. Methods and results: 139 asymptomatic T. cruzi seropositive subjects with normal heart size and normal LV ejection fraction (EF) (stage A or B) were enrolled in this prospective observational study and underwent paired echocardiograms at baseline and 1-year follow-up. Progressors were participants classified as stage C or D at follow-up due to development of symptoms of heart failure, cardiomegaly, or decrease in LVEF. LV GLS was calculated as the average peak systolic strain of 16 LV segments. Measurements were compared between participants who progressed and did not progress by two-sample t-test, and the odds of progression assessed by multivariable logistic regression. Of the 139 participants, 69.8% were female, mean age 55.8 ± 12.5 years, with 12 (8.6%) progressing to Stage C or D at follow-up. Progressors tended to be older, male, with wider QRS duration. LV GLS was −19.0% in progressors vs. –22.4% in non-progressors at baseline, with 71% higher odds of progression per +1% of GLS (adjusted OR 1.71, 95% CI 1.20–2.44, p = 0.003). Conclusion: Baseline LV GLS in participants with CCC stage A or B was predictive of progression within 1-year and may guide timing of clinical follow-up and promote early detection or treatment.
Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia
(Oxford University Press on behalf of the Infectious Diseases Society of America, 2018) Kaplinski, Michelle; Jois, Malasa; Galdos-Cardenas, Gerson; Rendell, Victoria R.; Shah, Vishal; Do, Rose Q.; Marcus, Rachel; Burroughs Pena, Melissa S.; Abastoﬂor, Maria del Carmen; LaFuente, Carlos; Bozo, Ricardo; Valencia, Edward; Verastegui, Manuela; Colanzi, Rony; Gilman, Robert H.; Bern, Caryn
Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia.
(2015) Kaplinski, Michelle; Jois, Malasa; Galdos-Cardenas, Gerson; Rendell, Victoria R; Shah, Vishal; Do, Rose Q; Marcus, Rachel; Pena, Melissa S Burroughs; Abastoflor, Maria del Carmen; LaFuente, Carlos; Bozo, Ricardo; Valencia, Edward; Verastegui, Manuela; Colanzi, Rony; Gilman, Robert H; Bern, Caryn
BACKGROUND: We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women. METHODS: Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG). RESULTS: Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house. CONCLUSIONS: We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.