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Heart failure & cardiomyopathiesCohort study

Cardioembolic stroke in Chagas cardiomyopathy: the interplay between apical aneurysm, left ventricular thrombus and clinical outcomes

HeartPublished

  • prospective cohort study
  • tertiary referral centre
  • genetic matching
  • causal mediation analysis
Read the original article ↗

Authors' conclusion

In CCM, CE stroke is primarily driven by LV thrombus formation. Apical aneurysm increases embolic risk mainly through thrombus mediation, while prior CE stroke identifies patients at increased risk for recurrence. These findings support targeted stroke prevention strategies focused on thrombus detection and anticoagulation.

Study context

Population
Patients with confirmed Chagas cardiomyopathy (CCM) enrolled at a tertiary referral centre between 2007 and 2022patients with confirmed CCM enrolled
Participants
518 patients
Exposure
Apical aneurysm vs no apical aneurysm for cardioembolic (CE) stroke; factors associated with all-cause mortality or heart transplantation

Main finding

As reported in the abstract

History of CE stroke at enrolment · enrolment

Patients with a history of CE stroke

73 patients (14.1%)

Observational data: associations, not effects.

Further findings

Factors associated with prior CE stroke (multivariable)

New York Heart Association (NYHA) functional class III/IV, lower left ventricular (LV) ejection fraction and LV thrombus independently associated with prior CE stroke; apical aneurysm was not
  • multivariable analyses

Apical aneurysm and CE stroke (matched analyses)

Proportion mediated through LV thrombus formation
63.3%
Significant association between apical aneurysm and CE stroke
  • matched analyses

Death or heart transplantation · mean follow-up of 4.9 years

Patients who died
174
Patients who underwent heart transplantation
22
NYHA functional class III/IV, right-sided heart failure, left atrial enlargement and lower LV ejection fraction independently associated with the composite outcome; neither prior CE stroke nor apical aneurysm associated with adverse outcomes

Incident CE stroke

Incident CE stroke
41 patients (9%)
Independently associated with prior CE stroke and LV thrombus

Original publication

Cardioembolic stroke in Chagas cardiomyopathy: the interplay between apical aneurysm, left ventricular thrombus and clinical outcomes. Heart. Published 28 July 2026. doi:10.1136/heartjnl-2026-328159
Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it