Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas

Abstract

OBJECTIVEDescribe the clinical and therapeutic characteristics of patients with heart failure (HF) secondary to chronic chagasic cardiomyopathy and evaluate if these characteristics are different from those found in other etiologies. METHODS RESULTSThree hundred and fi fty six patients diagnosed with HF were included in the study. Chagasic cardiomyopathy was the most common etiology (48% of the cases). Other etiologies included hypertensive cardiomyopathy in 19% of the patients, idiopathic dilated in 11% and ischemic in 9%. Patients with HF secondary to chagasic cardiomyopathy were more frequently from non-white ethnic groups (88 vs. 75%; p = 0.002), had a family history of Chagas disease (57 vs. 21%; p = 0.001), had the disease for a longer length of time (71 vs. 56 months; p = 0.034), had lower levels of education (4.4 ± 4.1 vs. 5.7 ± 4.2 years of study; p = 0.004), had a lower heart rate (69 ± 12 vs. 73 ± 13; p = 0.03) and a lower systolic blood pressure (121 ± 25 vs. 129 ± 28 mmHg; p = 0.006). There was also a higher incidence of the use of amiodarone (22 vs. 13%; p = 0.036) and artifi cial pacemakers (15 vs. 1%; p = 0.001). There was a lower usage of beta-blockers (39 vs. 59%; p = 0.001). CONCLUSIONIn this sample of HF outpatients, in a state with a high prevalence of Chagas disease, chagasic cardiomyopathy was the most common etiology and they presented some unique clinical and therapeutic characteristics in comparison to other heart failure patients. KEY WORDSChagasic cardiomyopathy, heart failure, epidemiology.

Perfil epidemiológico, clínico e terapêutico da insuficiência cardíaca em hospital terciário

“…These findings are in agreement with the results of several studies 13,14,27 and with the recommendations of the guidelines 1,8,18 for the treatment of HF in Brazil.…”

“…Although the World Health Organization (WHO) has certified the eradication of the vectorial transmission in our country, small endemic foci can still be found in Brazilian territory, resulting from an intense migratory process from rural to urban areas in the last decades. Similar results were obtained by Braga et al 14 in a study that sought to describe the clinical and therapeutic characteristics of HF due to Chagas' disease.…”

“…In spite of the lack of significance, the use of beta-blockers was indicated in 55.9% of the chagasic patients, which is different from the study by Braga et al 14 , in which these medications were used less frequently, mainly at moderate to high doses, due to the lower levels of systolic blood pressure and heart rate observed in patients with chagasic cardiomyopathy.…”

“…Ischemic cardiomyopathy was the least frequent etiology (17 cases -11.8%), in contrast with other studies 7,12,14,15 that identified it as the main cause of HF among the patients. The study by Rassi et al 12 , which evaluated survival and prognostic factors in systolic HF and was carried out in the state of Goiás, observed a higher frequency of ischemic cardiomyopathy, followed by chagasic cardiomyopathy.…”

“…The most frequent etiology was chagasic cardiomyopathy (41%), which can be explained by the fact that the Midwest region is considered one of the endemic areas of the disease in Brazil 10,14 . Although the World Health Organization (WHO) has certified the eradication of the vectorial transmission in our country, small endemic foci can still be found in Brazilian territory, resulting from an intense migratory process from rural to urban areas in the last decades.…”