New perspectives on chagasic cardiomyopathy: A narrative review of genetics, magnetic resonance imaging and therapeutic alternatives.

Chagasic cardiomyopathy is the chronic manifestation of American trypanosomiasis. In endemic regions of Peru, delayed diagnosis remains a major public health concern. This review analyzes recent evidence (2020 to 2026) regarding the impact of genetic variants on severity, the utility of cardiac magnetic resonance imaging, and the efficacy of trypanocidal and advanced support treatment. A search was conducted in PubMed and Scopus, prioritizing clinical trials and meta-analyses. Current data challenge the direct relationship between parasite lineage and cardiac severity, highlighting the host inflammatory response as the primary driver. Diagnostically, cardiac magnetic resonance imaging surpassed echocardiography in identifying early fibrosis and defining arrhythmic risk. Regarding therapy, benznidazole use during the indeterminate phase reduced the risk of clinical progression (Relative Risk (RR) 0.35), challenging traditional palliative approaches. In conclusion, current evidence repositions etiological treatment as a viable preventive strategy and underscores the importance of cardiac magnetic resonance imaging for early clinical management.