Miocardiopatia chagásica: uma revisão de conceitos e aspectos epidemiológicos, fisiopatológicos e do manejo terapêutico

Abstract

Introduction: Chagasic dilated cardiomyopathy (CDC) is the most severe chronic cardiac manifestation of Chagas disease, affecting millions of people in Latin America and gaining global relevance due to migratory movements. Objective: To synthesize and update recent evidence on the main epidemiological, pathophysiological, clinical, therapeutic, and economic aspects related to CDC. Methods: A narrative review of the literature was conducted using the PubMed, SciELO, and Google Scholar databases. Articles published between 2020 and 2025 in English, Spanish, and Portuguese, available in full text and with open access, were included. Results: The analyzed literature indicates that CDC results from a persistent immune response to Trypanosoma cruzi, leading to chronic inflammation, myocardial fibrosis, endothelial dysfunction, and progressive ventricular remodeling. These mechanisms result in chamber dilation, complex arrhythmias, heart failure, and sudden cardiac death. Treatment is based on contemporary heart failure guidelines and includes angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and sacubitril/valsartan, as well as devices such as implantable cardioverter-defibrillators and cardiac resynchronization therapy. Cardiovascular rehabilitation stands out as a complementary intervention. Economic analyses demonstrate a substantial burden of direct and indirect costs, particularly in endemic countries. Conclusion: CDC remains a major public health challenge. Its management requires integrated strategies for prevention, early diagnosis, etiological treatment, and specialized heart failure management, together with policies that address its economic impact.