# Sublingual microcirculatory alterations in Chagas disease: an observational study in an endemic rural population

## TL;DR

This study found changes in the tiny blood vessels under the tongue in people with Chagas disease, suggesting a potential new way to monitor the illness.

## Contribution

The study is the first to show sublingual microcirculatory changes in chronic Chagas disease using videomicroscopy in an endemic rural population.

## Key findings

- Chagas disease patients showed increased sublingual total and perfused microvascular density compared to controls.
- Angiogenesis may be the mechanism behind the observed microvascular changes in Chagas disease patients.

## Abstract

Chagas disease is a systemic illness with widespread microvascular involvement. Experimental and clinical studies suggest that functional and structural microcirculatory abnormalities might be relevant to the disease progression.

To show the presence of sublingual microcirculatory alterations in patients with chronic Chagas disease.

This was a cross-sectional study including adult patients with serologic diagnosis of Chagas disease (n = 41) and control volunteers with negative serology (n = 38), from an endemic rural population. Study participants underwent clinical, electrocardiographic, echocardiographic, and sublingual videomicroscopic assessment. Videos were acquired by a sidestream-dark-field (SDF) imaging device and evaluated by a software-assisted analysis (AVA 3.2 software).

Most of Chagas disease patients were in the indeterminate phase (n = 34) and had lower heart rate and more echocardiographic abnormalities than control group (50 vs. 26%, p = 0.03). They also exhibited higher small microvessels total and perfused vascular density (20.12 ± 2.33 vs. 19.05 ± 2.25 and 20.03 ± 2.28 vs. 19.01 ± 2.25 mm/mm2, p < 0.05 for both). Other microvascular variables did not differ between groups.

Patients with chronic Chagas disease exhibited increases in sublingual total and perfused microvascular density. Angiogenesis might be the underlying mechanism. The videomicroscopic assessment of mucosal sublingual microcirculation might be an additional tool in the monitoring of Chagas disease.