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Chagas Disease Cardiac Progression Index (CPI) Calculator

  • Clinical phase
  • Follow-up horizon (years)
  • Chagas Disease Cardiac Progression Index (CPI): Explanation and Clinical Context
     This calculator estimates the risk that a patient with Chagas disease will progress to clinically manifest cardiomyopathy over a specified time horizon using pooled annual incidence rates. For individuals with the indeterminate chronic form (no baseline cardiac injury on ECG/echocardiography), the pooled annual incidence of progression to cardiomyopathy is approximately 1.9% per year; for patients in the acute phase, the pooled annual incidence is approximately 4.6% per year. Assuming a constant annual hazard, the cumulative risk over t years is calculated as Risk(t) = 1 − (1 − r)t, where r is the annual rate as a proportion. This provides a transparent, incidence-based estimate that can be tailored to the patient’s anticipated follow-up duration.

    Clinical significance
    Risk of progression informs surveillance intensity, timing of echocardiography and ECG monitoring, and decisions about etiologic treatment. While the cumulative-risk model reflects population-level data, individual variation exists depending on disease activity and myocardial injury markers. Evidence suggests that male sex, higher anti–T. cruzi antibody titers, and myocardial fibrosis on cardiac MRI are associated with higher risk. No validated individual prediction model is yet in routine use, so this CPI should be interpreted alongside clinical judgment and adjunct investigations (ECG, echo, natriuretic peptides, or CMR).

    Clinical interpretation summary
    A higher cumulative risk indicates a greater likelihood of developing cardiomyopathy during the chosen follow-up period. For example, with a 1.9% annual rate, a 5-year cumulative risk is about 9.2%; with 4.6% per year, it’s about 21.1%. Patients with high-risk features (e.g., myocardial fibrosis, elevated natriuretic peptides, or early echocardiographic changes) warrant closer follow-up.

    Reference:
    Chadalawada S, et al. Risk of Chronic Cardiomyopathy in Patients With Acute or Indeterminate Chagas Infection. JAMA Netw Open. 2020;3(8):e2015072. doi:10.1001/jamanetworkopen.2020.15072.
    Hasslocher-Moreno AM, et al. Progression Rate from the Indeterminate Form to the Cardiac Form in Chronic Chagas Disease: 22-Year Follow-Up. Trop Med Infect Dis. 2020;5(2):76. doi:10.3390/tropicalmed5020076.
    Basquiera AL, et al. Risk progression to chronic Chagas cardiomyopathy. Heart. 2003;89(8):999–1004. doi:10.1136/heart.89.8.999.
    Nunes MCP, et al. Long-Term Follow-Up of T. cruzi–Seropositive Blood Donors Shows Antibody Titer as a Marker of Disease Activity. Circulation. 2021;144(9):728–741. doi:10.1161/CIRCULATIONAHA.121.055112.
    Nunes MCP, et al. Clinical features of Chagas disease progression and severity. Lancet Reg Health – Am. 2024;28:100661. doi:10.1016/j.lana.2024.100661.
    Carvalho BN, et al. Myocardial Fibrosis on CMR in Indeterminate Chagas Disease. Arq Bras Cardiol. 2018;110(4):364–373. doi:10.5935/abc.20180016