Estudo de fatores pró-trombóticos e pró-inflamatórios na cardiomiopatia chagásica

Melo, Leônidas Carrijo Azevedo; Souza, Germano Emílio Conceição; Valim, Leandro Richa; Moreira, Luíz Felipe Pinho; D'Ámico, Elbio Antônio; Rocha, Tânia Rúbia Flores da; Barretto, Antônio Carlos Pereira; Strunz, Celia Maria Cassaro; Bocchi, Edimar Alcides; Ramires, José Antônio Franchini

doi:10.1590/s0066-782x2010005000146

Cited by 11 publications

(9 citation statements)

References 25 publications

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“…Our results concerning progressive heart failure death are in concordance with other previous publications that included chagasic patients also under outdated treatment [17], [18]. Our finding of high incidence of stroke causing death in Chagas disease in comparison with other etiologies confirms previous studies [18], [19] despite the unexpected recently reported lack of evidence of pro-thrombotic status among patients with Chagas disease [20]. However, cardiac embolus originating from apical aneurysm and left ventricular thrombosis are a recurrent cause of Chagas stroke [21].…”

Section: Discussionsupporting

confidence: 92%

Mode of Death on Chagas Heart Disease: Comparison with Other Etiologies. A Subanalysis of the REMADHE Prospective Trial

et al. 2013

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BackgroundSudden death has been considered the main cause of death in patients with Chagas heart disease. Nevertheless, this information comes from a period before the introduction of drugs that changed the natural history of heart failure. We sought to study the mode of death of patients with heart failure caused by Chagas heart disease, comparing with non-Chagas cardiomyopathy.Methods and resultsWe examined the REMADHE trial and grouped patients according to etiology (Chagas vs non-Chagas) and mode of death. The primary end-point was all-cause, heart failure and sudden death mortality; 342 patients were analyzed and 185 (54.1%) died. Death occurred in 56.4% Chagas patients and 53.7% non-Chagas patients. The cumulative incidence of all-cause mortality and heart failure mortality was significantly higher in Chagas patients compared to non-Chagas. There was no difference in the cumulative incidence of sudden death mortality between the two groups. In the Cox regression model, Chagas etiology (HR 2.76; CI 1.34–5.69; p = 0.006), LVEDD (left ventricular end diastolic diameter) (HR 1.07; CI 1.04–1.10; p<0.001), creatinine clearance (HR 0.98; CI 0.97–0.99; p = 0.006) and use of amiodarone (HR 3.05; CI 1.47–6.34; p = 0.003) were independently associated with heart failure mortality. LVEDD (HR 1.04; CI 1.01–1.07; p = 0.005) and use of beta-blocker (HR 0.52; CI 0.34–0.94; p = 0.014) were independently associated with sudden death mortality.ConclusionsIn severe Chagas heart disease, progressive heart failure is the most important mode of death. These data challenge the current understanding of Chagas heart disease and may have implications in the selection of treatment choices, considering the mode of death.Trial RegistrationClinicalTrails.gov NCT00505050 (REMADHE)

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Section: Discussionsupporting

confidence: 92%

Mode of Death on Chagas Heart Disease: Comparison with Other Etiologies. A Subanalysis of the REMADHE Prospective Trial

et al. 2013

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“…Another important point to be considered is the absolute hegemony of studies carried out in Brazil (77% of those included in this review) 4,6-9,11,12,14-19,21-26,28-36,38,40-43 . Among the five studies performed in other countries, three were carried out in Latin America 13,20,27 and two in Europe 37,39 .…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the use of comparison groups, it was observed that in 18 articles (58%) the authors used the design of comparisons between groups 8,13-18,21,24,26,27,31,35,37,33,40-41,43 . It is also interesting to note the predominance of adult patients in the selected studies, with only one study including adolescent chagasic patients 23 .…”

Section: Resultsmentioning

confidence: 99%

“…As for the addressed topics, 10 articles considered prognostic factors of mortality and risk of disease progression using echocardiography 13,19,22,23,26,28,30,32,35,36 , five studies assessed left ventricular ejection fraction (LVEF) 20,25,29,34,39 , alone or together with prognostic factors, seven articles assessed systolic and diastolic ventricular function with tissue Doppler 15-17,27,33,36,40 , five assessed concentrations of brain natriuretic peptide (BNP) 21,24,29,31,37 , one study assessed the prognostic value of troponin concentrations 18 , one study evaluated ventricular dyssynchrony 38 , two studies assessed cardiac dysautonomia 14,41 , two studies used two-dimensional echocardiography to assess ventricular deformation (strain, strain rate and twisting) 33,42 and one study addressed the proinflammatory and prothrombotic factors in Chagas disease 43 .…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the search for new methodologies for cardiac function assessment, the association between inflammatory and prothrombotic activity in Chagasic cardiomyopathy has been investigated in an attempt to better characterize the disease, as to attain better care of these patients 43 . Such studies are relevant to the elucidation of the damage of chronic Chagas cardiomyopathy, so that it will no longer be included in the group of neglected diseases, considering that after 100 years of its discovery, it is still a serious public health problem.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Echocardiographic Predictors of Mortality in Chagasic Cardiomyopathy - Systematic Review

Júnior¹,

Filho²

2014

Arquivos Brasileiros De Cardiologia

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Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed), LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease.

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Altered Hypercoagulability Factors in Patients with Chronic Chagas Disease: Potential Biomarkers of Therapeutic Response

et al. 2016

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Thromboembolic events were described in patients with Chagas disease without cardiomyopathy. We aim to confirm if there is a hypercoagulable state in these patients and to determine if there is an early normalization of hemostasis factors after antiparasitic treatment. Ninety-nine individuals from Chagas disease-endemic areas were classified in two groups: G1, with T.cruzi infection (n = 56); G2, healthy individuals (n = 43). Twenty-four hemostasis factors were measured at baseline. G1 patients treated with benznidazole were followed for 36 months, recording clinical parameters and performance of conventional serology, chemiluminescent enzyme-linked immunosorbent assay (trypomastigote-derived glycosylphosphatidylinositol-anchored mucins), quantitative polymerase chain reaction, and hemostasis tests every 6-month visits. Prothrombin fragment 1+2 (F1+2) and endogenous thrombin potential (ETP) were abnormally expressed in 77% and 50% of infected patients at baseline but returned to and remained at normal levels shortly after treatment in 76% and 96% of cases, respectively. Plasmin-antiplasmin complexes (PAP) were altered before treatment in 32% of G1 patients but normalized in 94% of cases several months after treatment. None of the patients with normal F1+2 values during follow-up had a positive qRT-PCR result, but 3/24 patients (13%) with normal ETP values did. In a percentage of chronic T. cruzi infected patients treated with benznidazole, altered coagulation markers returned into normal levels. F1+2, ETP and PAP could be useful markers for assessing sustained response to benznidazole.

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Estudo de fatores pró-trombóticos e pró-inflamatórios na cardiomiopatia chagásica

Abstract: There is no evidence of greater pro-thrombotic status among patients with Chagas disease. The levels of fibrinogen and the MA, G and TG parameters of the thromboelastography point to pro-thrombotic status among non-chagas patients. Both groups had increased inflammatory activity.

Cited by 11 publications

References 25 publications

Mode of Death on Chagas Heart Disease: Comparison with Other Etiologies. A Subanalysis of the REMADHE Prospective Trial

Mode of Death on Chagas Heart Disease: Comparison with Other Etiologies. A Subanalysis of the REMADHE Prospective Trial

Clinical and Echocardiographic Predictors of Mortality in Chagasic Cardiomyopathy - Systematic Review

Altered Hypercoagulability Factors in Patients with Chronic Chagas Disease: Potential Biomarkers of Therapeutic Response

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