Classification for Chagas Cardiomyopathy

Chagas' disease is caused by a protozoan parasite, Trypanosoma cruzi, that is transmitted to humans through the feces of infected bloodsucking insects in endemic areas of Latin America, or occasionally by nonvectorial mechanisms, such as blood transfusion. Cardiac involvement, which typically appears decades after the initial infection, may result in cardiac arrhythmias, ventricular aneurysm, congestive heart failure, thromboembolism, and sudden cardiac death.

Chagas cardiomyopathy: classification according to American College of Cardiology/American Heart Association
A: Normal ECG findings, normal heart size, normal left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class I
B: Abnormal ECG findings, normal heart size, normal LVEF, NYHA class I
C: Abnormal ECG findings, increased heart size, decreased LVEF, NYHA class II-III
D: Abnormal ECG findings, increased heart size, decreased LVEF, NYHA class IV

Chagas cardiomyopathy: Brazilian consensus classification
A: Abnormal ECG findings, normal echocardiogram findings, no signs of CHF
B1: Abnormal ECG findings, abnormal echocardiogram findings with LVEF >45%, no signs of CHF
B2: Abnormal ECG findings, abnormal echocardiogram findings with LVEF <45%, no signs of CHF
C: Abnormal ECG findings, abnormal echocardiogram findings, compensated CHF
D: Abnormal ECG findings, abnormal echocardiogram findings, refractory CHF

Chagas cardiomyopathy: modified Los Andes classification
IA: Normal ECG findings, normal echocardiogram findings, no signs of CHF
IB: Normal ECG findings, abnormal echocardiogram findings, no signs of CHF
II: Abnormal ECG findings, abnormal echocardiogram findings, no signs of CHF
III: Abnormal ECG findings, abnormal echocardiogram findings, CHF

Chagas cardiomyopathy: modified Kuschnir classification
0: Normal ECG findings and normal heart size (usually based on chest radiography)
I: Abnormal ECG findings and normal heart size (usually based on chest radiography)
II: Left ventricular enlargement
III: Congestive heart failure


References

1. Acquatella H. Echocardiography in Chagas heart disease. Circulation. 2007 Mar 6;115(9):1124-31. [Medline]
2. Andrade JP, Marin Neto JA, Paola AA, Vilas-Boas F, Oliveira GM, Bacal F, Bocchi EA, Almeida DR, Fragata Filho AA, Moreira Mda C, Xavier SS, Oliveira Junior WA, Dias JC. I Latin American Guidelines for the diagnosis and treatment of chagas' heart disease: executive summary. Arq Bras Cardiol. 2011 Jun;96(6):434-42. [Medline]
3. Carrasco HA, Barboza JS, Inglessis G, Fuenmayor A, Molina C. Left ventricular cineangiography in Chagas' disease: detection of early myocardial damage. Am Heart J. 1982 Sep;104(3):595-602 [Medline]
4. Kuschnir E, Sgammini H, Castro R, Evequoz C, Ledesma R, Brunetto J. Evaluation of cardiac function by radioisotopic angiography, in patients with chronic Chagas cardiopathy. Arq Bras Cardiol. 1985 Oct;45(4):249-56. [Medline]