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| Early
Detection of Chagas Disease Based on the Surface ECG
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| Chagas disease is one
of the
most serious parasitic diseases of Latin America, with a social
and economic impact far outweighing the combined effects of other
parasitic diseases such as malaria,leishmaniasis and schistosomiasis. Serological data indicate well over 16 million people are infected with the causative agent, Trypanosoma cruzi, with a further 100 million people considered at risk. The World Bank, in 1993,calculated an annual loss due to Chagas disease of 2,740,000 `disability-adjusted life years' (DALYs), representing an economic loss to the endemic countries of Latin America equivalent to over US$6.5 billion per year. Chagas disease gradually affects the cardiovascular system through a process that can take about 20 to 30 years. Chagas disease can be transmitted by several mechanisms. Numerically however, vector-borne transmission is the most important, generally accounting for over 80% of all transmission of T. cruzi to humans. Regrettably, neither vaccines to prevent infection, nor drugs suitable for large-scale treatment, are currently available, but techniques for the interruption of transmission are now well established and are being progressively implemented throughout the endemic areas of Latin America. Our research in this subject is related to the early detection of the Chagas disease based on the analysis of the surface ECG signal by considering several advanced digital signal processing techniques. This approach is useful to detect the illness stage by non-invasive procedures. Schlegel et al. have recently developed advanced electrocardiographic software that can detect real-time changes within the high frequency (HF) components present within the central portion of the QRS complex of the conventional electrocardiogram (ECG). The developed software uniquely acquires, processes, analyzes, and displays the characteristics of the HF QRS components in each of the 12 ECG leads. In previous investigations, the use of a high resolution ECG has proven to be a highly sensitive tool for diagnosing cardiovascular disorders. Cardiac involvement is the most prominent manifestation in Chagas’ disease, and Trypanosoma cruzi. Sudden arrhythmic heart failure, manifested from Chagas’ disease, is the leading cause of cardiovascular mortality in endemic areas. Early detection of Chagas' cardiomyopathy (CM) based on analysis of the surface 12-lead ECG signal, if sufficiently sensitive and specific, would provide a non-invasive diagnostic approach that could potentially be made available to a large population at-risk for sudden death from Chagas' cardiomyopathy. The principal aims of this study are to determine whether resting 12-lead HF QRS ECG can: 1) detect subclinical chagasic CM in patients with recently diagnosed Chagas’ disease (i.e., recent seropositivity) who as of yet do not have any overt cardiopulmonary symptoms; and 2) predict future ventricular arrhythmia and sudden cardiac death during any stage of chagasic CM. |