The Prevalence and Impact of Chagas Disease Among Latin American Immigrants With Non-Ischemic Cardiomyopathy in Los Angeles, California

Background —Chagas disease (CD) is a well-known cause of cardiomyopathy in Latin America, however, 300,000 individuals are estimated to have CD in the United States (US). This study examined the prevalence and impact of Chagas cardiomyopathy (CCM) in a US population. We hypothesized that patients with CCM would have increased morbidity and mortality as compared to patients with non-CCM. Methods and Results —This is a single-center, prospective cohort study. Enrollment criteria were new diagnosis of non-ischemic CM (left ventricular ejection fraction ≤ 40%) and previous residence in Latin America for at least 12 months. Serologic testing for Trypanosoma cruzi was performed at enrollment. The primary end point was all-cause mortality or heart transplantation. The secondary end point was heart failure (HF)-related hospitalization. A total of 135 patients were enrolled, with a median of 43 months of follow-up. CD was diagnosed in 25 (19%) patients. The primary end point occurred in 9 patients (36%) in the CCM group and in 11 patients (10%) in the non-CCM group (hazard ratio [HR]: 4.46, 95% confidence interval [CI]: 1.8 to 10.8, p = 0.001). The secondary end point occurred in 13 patients (52%) in the CCM group and in 35 patients (32%) in the non-CCM group (HR: 2.22, 95% CI: 1.2 to 4.2, p = 0.01). Conclusions —There is a high prevalence of CD among Latin American immigrants diagnosed with non-ischemic CM in Los Angeles. Advanced CCM portends a poor prognosis and is associated with increased all-cause mortality/heart transplantation and HF-related hospitalization.