{
  "abstract": "Chagas cardiomyopathy, caused by chronic infection with Trypanosoma cruzi, is a leading cause of non-ischaemic heart failure in Latin America and is increasingly recognised worldwide due to migration. Its pathogenesis is multifactorial, involving persistent parasitism, immune-mediated myocardial injury, microvascular dysfunction and progressive fibrosis, leading to a heterogeneous clinical spectrum. Four main phenotypes are recognised, including subclinical, arrhythmic, heart failure and thromboembolic, which often overlap and evolve throughout the disease course.Diagnosis relies on serological confirmation of T. cruzi infection, with electrocardiography and echocardiography forming the cornerstone of cardiac evaluation and risk stratification. Management includes antiparasitic therapy for acute, congenital and early chronic infection, and guideline-directed heart failure and arrhythmia management in established cardiomyopathy, including device therapy and heart transplantation in advanced cases.Despite advances in understanding disease mechanisms and clinical management, early detection remains a major challenge, particularly in non-endemic settings where under-recognition and limited access to specialised care persist. Strengthening screening strategies, expanding access to diagnostic tools and implementing multidisciplinary care models are critical to improving outcomes.This state-of-the-art review summarises current evidence on the pathophysiology, clinical spectrum, diagnosis and management of Chagas cardiomyopathy and highlights key controversies, knowledge gaps and research priorities to guide future advances in care.",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil",
        "Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Maria Carmo Pereira Nunes"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil",
        "Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Antonio Luiz Pinho Ribeiro"
    },
    {
      "affiliations": [
        "Laboratório Biologia das Interações Celulares, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Walderez Dutra"
    },
    {
      "affiliations": [
        "Cardiology and Cardiovascular Surgery Service, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Gustavo Araujo Silva"
    },
    {
      "affiliations": [
        "Cardiology and Cardiovascular Surgery Service, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Andre A L Carmo"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Fernando Antonio Botoni"
    },
    {
      "affiliations": [
        "Tropical Medicine and International Health Unit, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Israel Molina"
    },
    {
      "affiliations": [
        "Instituto de Medicina Tropical, Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Ester Sabino"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Caryn Bern"
    }
  ],
  "title": "Chagas cardiomyopathy",
  "uid": "27e9bc13-e644-55b0-80ad-8896fd6fa931"
}