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The three pathophysiological mechanisms with the largest impact on this differential mortality include rapidly progressive heart failure, a high incidence of stroke, and a high burden of ventricular arrhythmias. However, despite significant advances in understanding the unique molecular circuits underlying these mechanisms, the new knowledge acquired has not been efficiently translated into specific diagnostic and therapeutic approaches for this unique cardiomyopathy. The lack of dedicated clinical trials and the limited CCC\u2010specific risk stratification tools available are evidence of this reality. This review aims to provide an updated perspective of the evidence and pathophysiological mechanisms associated with the higher mortality observed in CCC compared to other cardiomyopathies and highlight opportunities in the diagnostic and therapeutic approaches of the disease.\n                  <\/jats:p>","DOI":"10.1002\/ejhf.3460","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T02:14:29Z","timestamp":1727403269000},"page":"2502-2514","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Mechanisms behind the high mortality rate in chronic\n                    <scp>Chagas<\/scp>\n                    cardiomyopathy: Unmasking a three\u2010headed monster"],"prefix":"10.1093","volume":"26","author":[{"given":"Luis E.","family":"Echeverr\u00eda","sequence":"first","affiliation":[{"name":"Heart Failure and Transplant Clinic Fundaci\u00f3n Cardiovascular de Colombia  Floridablanca Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angie Yarlady","family":"Serrano\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Heart Failure and Transplant Clinic Fundaci\u00f3n Cardiovascular de Colombia  Floridablanca Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyda Z.","family":"Rojas","sequence":"additional","affiliation":[{"name":"Research Center Fundaci\u00f3n Cardiovascular de Colombia  Floridablanca Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique A.","family":"Berrios\u2010B\u00e1rcenas","sequence":"additional","affiliation":[{"name":"Outpatient Clinic, Cardiovascular Risk Factors Clinic Instituto Nacional de Cardiolog\u00eda \u2018Ignacio Ch\u00e1vez\u2019  Ciudad de M\u00e9xico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Esteban","family":"G\u00f3mez\u2010Mesa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Fundaci\u00f3n Valle del Lili Universidad Icesi, Faculty of Medicine  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio A.","family":"G\u00f3mez\u2010Ochoa","sequence":"additional","affiliation":[{"name":"Heart Failure and Transplant Clinic Fundaci\u00f3n Cardiovascular de Colombia  Floridablanca Colombia"},{"name":"Department of General Internal Medicine and Psychosomatics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.5334\/gh.484"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2012.03.002"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl\u20102017\u2010312869"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2023.101964"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.14164"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2024.02.014"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.004361"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms231810456"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0258622"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11247262"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13648"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens10111493"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.5334\/gh.1150"},{"key":"e_1_2_9_15_1","unstructured":"Institute for Health Metrics and Evaluation (IHME).Epi Visualization. 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