{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:58:29Z","timestamp":1791089909504,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2013,3,12]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>\n              Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic\n              <jats:italic>Trypanosoma cruzi<\/jats:italic>\n              \u2013infected persons.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We performed a retrospective cohort study among initially healthy blood donors with an index\n              <jats:italic>T cruzi<\/jats:italic>\n              \u2013seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of S\u00e3o Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499\n              <jats:italic>T cruzi<\/jats:italic>\n              seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488\n              <jats:italic>T cruzi<\/jats:italic>\n              seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to\n              <jats:italic>T cruzi<\/jats:italic>\n              infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction &lt;50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) with male sex, a history of abnormal ECG, and the presence of an S\n              <jats:sub>3<\/jats:sub>\n              heart sound.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>\n              There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic\n              <jats:italic>T cruzi<\/jats:italic>\n              \u2013seropositive blood donors, although disease was mild at diagnosis.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.112.123612","type":"journal-article","created":{"date-parts":[[2013,2,8]],"date-time":"2013-02-08T07:43:57Z","timestamp":1360309437000},"page":"1105-1115","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":152,"title":["Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic\n            <i>Trypanosoma cruzi<\/i>\n            \u2013Seropositive Former Blood Donors"],"prefix":"10.1161","volume":"127","author":[{"given":"Ester C.","family":"Sabino","sequence":"first","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio L.","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera M.C.","family":"Salemi","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Di Lorenzo Oliveira","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre P.","family":"Antunes","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia M.","family":"Menezes","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara M.","family":"Ianni","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Nastari","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Fernandes","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina M.","family":"Patavino","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandana","family":"Sachdev","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligia","family":"Capuani","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar","family":"de Almeida-Neto","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M.","family":"Carrick","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); Hospital das Cl\u00ednicas and the Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.); Cardiomyopathy Unit of the Heart Institute (InCor) da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil (V.M.C.S., B.M.I., L.N., F.F.); Campus Dona Lindu da Universidade Federal de S\u00e3o Jo\u00e3o del-Rei, Divin\u00f3polis, Brazil (C.D.L.O...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wright","sequence":"additional","affiliation":[{"name":"From the Department of Infectious Disease and Institute of Tropical Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil (E.C.S.); 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