A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

“…With respect to the alpha-beta-blocker drug carvedilol, one study in our laboratory demonstrated that when this drug was administered to subjects with heart failure due to Chagas disease 98 or other aetiologies 99 , improvement of depressed cardiac autonomic modulation was observed, as evidenced by enhanced heart rate variability associate with better hemodynamic and clinical status. In other study in chagasics with cardiomyopathy and heart failure, the same functional cardiac and clinical benefits were observed after addition of carvedilol to conventional theray 100 . Therefore, knowledge about the cardiac autonomic dysfunction in Chagas disease has implications that reach far beyond its functional and clinical significance.…”

Short-term therapy with simvastatin reduces inflammatory mediators and heart inflammation during the acute phase of experimental Chagas disease

“…Therefore, cardiovascular drugs that are routinely used (e.g., ACE inhibitors, beta-blockers and others) have been tested for the treatment of Chagas disease. With a new anti-inflammatory focus, studies have demonstrated a drastic reduction in leukocyte infiltration in the heart, fibrosis, circulating inflammatory cytokines/chemokines and improvements in cardiac output ventricular functions in Chagas disease (Morris et al 1989, Leon et al 2003, Botoni et al 2007, Coelho dos , Paula-Costa et al 2010. Because of these results, new therapeutic targets based on statins, a lipid-modifying agent HMG-CoA, have emerged as a method to prevent cardiovascular diseases (Liao 2002, Cheng et al 2005, Mizuno et al 2011.…”

“…Newly developed cardiovascular therapeutics (e.g., ACE-inhibitors and beta-blockers) have been shown to reduce inflammatory infiltration, fibrosis, cardiac output ventricular function and circulating inflammatory cytokines and chemokines in experimental and human studies (Leon et al 2003, Botoni et al 2007, Paula-Costa et al 2010, Coelho dos Santos et al 2010). More recently, by blocking the conversion of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) to mevalonate, HMG CoA reductase inhibitors (statins) have emerged as potent inhibitors of cholesterol and isoprenoid biosynthesis (Liao 2002).…”

Morbidity and prognostic factors in chronic chagasic cardiopathy

“…Previous studies have demonstrated a poorer prognosis for patients with Chagas cardiomyopathy than for those with other causes of heart failure (Freitas et al 2005Campos Lopes et al 2006, Silva et al 2008). Very few clinical trials (Roberti et al 1992, Khoury et al 1996, Davila et al 2002, Botoni et al 2007b) have been carried out on patients with Chagas heart failure and some of those were short-term, non-randomised studies. Nonetheless, the treatment guidelines for heart failure due to other conditions (Hunt et al 2005) are generally applied to treatment of the condition in the Chagas disease population.…”

“…Nonetheless, the treatment guidelines for heart failure due to other conditions (Hunt et al 2005) are generally applied to treatment of the condition in the Chagas disease population. The direct transposition of recommendations derived from studies on heart failure from other aetiologies in patients generally from Europe and North America to Latin American Chagas disease patients is potentially misleading (Botoni et al 2007b). Moreover, the physician's perception that Chagas disease is a distinct condition may lead to suboptimal dosing or a lack of initiation of medications with proven efficacy in patients with other heart failure aetiologies (Botoni et al 2007a).…”