The Selvester QRS score as an estimative of myocardial injury in acute chagasic patients from the Brazilian Amazon

BMC Infect Dis. 2021 Apr 29;21(1):396. doi: 10.1186/s12879-021-06083-x.


Background: In the Brazilian Amazon, a new epidemiological profile of Chagas disease transmission, the oral route, has been detected and cited as being responsible for the increase in acute cases in Brazil. The clinical evaluation of acute Chagas disease (ACD) has been a challenge since it can progress to a chronic phase with cardiac alterations, and the follow-up by modern diagnostic methods is very difficult due to the socio-geographical characteristics of the Brazilian Amazon. Thus, alternatives should be sought to alleviate this problem. We conducted a study to evaluate subjects with ACD using the 12-lead ECG QRS score (Selvester score) as an estimative of myocardial injury progression before and after ACD treatment.

Methods: The study included indigenous subjects from the Amazon region with ACD in clinical follow-up at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) Chagas Disease outpatient clinic in the state of Amazonas, Brazil. The control group consisted of 31 healthy volunteers with no history of heart disease and no reactive serology for Chagas disease. Baseline ECG was performed in all subjects. The Selvester scoring method was performed according to the standardized guide (< 3 points: no myocardial injury,> 3: points × 3% = % of the predicted LV infarction).

Results: A total of 62 subjects were included, 31 as cases and 31 as controls. The mean follow-up of the case group was 17 months. The control group presented normal ECG. The case group presented 13 alterations before treatment and 11 after. Nineteen individuals presented scores > 3 points, 6 before and 13 after. In 19.36% of subjects, myocardial injury was found before treatment and in 41.94% after treatment.

Conclusion: This is the first study that uses the Selvester score (SS) to predict myocardial injury in subjects with ACD. The results of this study suggest the significant presence of myocardial injury from the beginning of treatment to the period post treatment of ACD, which demonstrates that the SS can be applied for stratification and follow-up of Chagas disease in the Amazon region.

Keywords: Brazilian Amazon; Chagas disease; Myocardial injury; Selvester score.

MeSH terms

  • Adult
  • Brazil / ethnology
  • Chagas Disease / complications
  • Chagas Disease / drug therapy
  • Chagas Disease / physiopathology*
  • Coronary Artery Disease / diagnostic imaging
  • Electrocardiography / methods*
  • Female
  • Heart / diagnostic imaging
  • Heart / physiopathology*
  • Humans
  • Indigenous Peoples
  • Longitudinal Studies
  • Male
  • Middle Aged