Outcome of Chagas cardiomyopathy in comparison to ischemic cardiomyopathy

Boas, Luciana G.C. Vilas; Bestetti, Reinaldo B.; Otaviano, Ana Paula; Cardinalli-Neto, Augusto; Nogueira, Paulo Roberto

doi:10.1016/j.ijcard.2012.01.033

Cited by 39 publications

(39 citation statements)

References 42 publications

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“…27 Although several prior studies have compared individuals with Chagasic HFrEF to others with ischemic or nonischemic cardiomyopathy (but not both concomitantly), these have been mainly single-center reports of often highly selected cohorts (eg, transplant referrals) usually markedly undertreated by contemporary standards. [12][13][14][15][16][17][18][19][20]28 These prior reports included between 25 and 246 patients with Chagas' cardiomyopathy and 50 to 454 patients in the comparator group, usually did not report detailed characterization of participants (eg, in relation to prior history and biomarkers) and often did not adjust for differences in a multivariable analysis when comparing outcomes across etiologic groups. [13][14][15][16][17][18][19][20][21]28 Despite these differences, it is possible to make some comparisons with our findings.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18][19][20]28 These prior reports included between 25 and 246 patients with Chagas' cardiomyopathy and 50 to 454 patients in the comparator group, usually did not report detailed characterization of participants (eg, in relation to prior history and biomarkers) and often did not adjust for differences in a multivariable analysis when comparing outcomes across etiologic groups. [13][14][15][16][17][18][19][20][21]28 Despite these differences, it is possible to make some comparisons with our findings. In both the prior studies and in ours, Chagasic patients were notable by their younger age and lower preponderance of males (especially when compared with patients with ischemic HFrEF).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] Despite the high prevalence of Chagas' disease, little is known about the morbidity and mortality in patients with HFrEF caused by Chagas' disease, compared with other etiologies, especially in the modern era of heart failure (HF) therapies. [13][14][15][16][17][18][19][20][21] We pooled the 2 largest and most recent trials in HFrEF, the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and the ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart failure Trial), to look further into investigator-reported Chagasic HF in Latin America. 22,23…”

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confidence: 99%

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Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Shen

Ramires

Martínez

et al. 2017

Circ: Heart Failure

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Shen

Ramires

Martínez

et al. 2017

Circ: Heart Failure

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“…8 The prognosis of patients with Chagas cardiomyopathy with CHF is poorer than that observed not only in patients with mild to moderate CHF, 9 but also in those with advanced CHF. 10 Moreover, outcome of patients with Chagas cardiomyopathy with CHF are worse than that of patients with CHF secondary to Idiopathic Dilated Cardiomyopathy, 11,12 ischemic cardiomyopathy, 13 and hypertensive cardiomyopathy. 14 There is no evidence-based guideline to guide the treatment of Chagas cardiomyopathy patients with CHF largely because this International Cardiovascular Forum Journal 7 (2016) DOI: 10.17987/icfj.v7i0.217 disease is neglected.…”

Section: Introductionmentioning

confidence: 99%

The treatment of chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era

Bestetti¹,

Daniel²

2016

ICFJ

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<p>Chronic Heart Failure (CHF) affects about half patients with Chagas cardiomyopathy. Outcome of CHF secondary to Chagas cardiomyopathy is relentless with an annual mortality approaching 20%, which is higher than that observed in non-Chagas disease heart failure. The pathophysiology of Chagas disease is similar to that found in non-Chagas disease heart failure with a marked activation of the neurohormonal system. No randomized trial has been conducted in patients with Chagas cardiomyopathy with CHF to assess the effect of a drug on mortality of such patients. Therefore, the treatment of CHF secondary to Chagas cardiomyopathy relies on drugs prescribed to patients with non-Chagas disease heart failure<strong>. </strong>Patients with Chagas disease heart failure have been classified into stages A to D according to the American College of Cardiology/American Heart Association. Little can be done to patients in the stage A of CHF, except for treatment of comorbidities. In patients in the stage B of CHF, aldosterone receptor antagonist, angiotensin converting enzyme inhibitors (ACEI), and Betablockers (BB) can be indicated. In patients in the stage C of CHF, the same drugs are of value. In addition, diuretics, digoxin, angiotensin receptor blockers to patients intolerant to ACEI have also been used. Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator may have indications similar to that of non-Chagas disease patients. In stage D of CHF, heart transplantation is a valid option for patients with this condition. </p>

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“…Advanced heart failure of any etiology is associated with shortened survival, but multiple investigations have shown that heart failure from Chagas disease carries a particularly poor prognosis (3) (4) (5) (6) (7). …”

Section: Introductionmentioning

confidence: 99%

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Sherbuk

Okamoto

Marks

et al. 2015

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Background Chagas cardiomyopathy is a chronic sequela of infection by the parasite, Trypanosoma cruzi. Advanced cardiomyopathy is associated with a high mortality rate, and clinical characteristics have been used to predict mortality risk. Though multiple biomarkers have been associated with Chagas cardiomyopathy, it is unknown how these are related to survival. Objectives Our study aimed to identify biomarkers associated with mortality in individuals with severe Chagas cardiomyopathy in an urban Bolivian hospital. Methods The population included individuals with and without T. cruzi infection recruited in an urban hospital in Santa Cruz, Bolivia. Baseline characteristics, ECG findings, medications, and serum cardiac biomarker levels (BNP, NTproBNP, CKMB, troponin I, MMP-2, MMP-9, TIMP-1, TIMP-2, TGFb1, and TGFb2) were ascertained. Echocardiograms were preferentially performed on those with cardiac symptoms or electrocardiogram abnormalities. Participants were contacted by phone approximately 1 year after initial evaluation; deaths were reported by family members. Receiver operating characteristic curves were used to optimize cut-off values for each marker. For markers with area under curve > 0.55, Cox proportional hazards models were performed to determine the hazards ratio (HR) and 95% confidence interval (CI) for the association of each marker with mortality. Results The median follow-up time was 14.1 months (interquartile range 12.5- 16.7 months). Of 254 individuals with complete cardiac data, 220 (87%) had follow-up data. Of 50 patients with severe Chagas cardiomyopathy, 20 (40%) had died. Higher baseline levels of BNP (HR[95% CI]:3.1 [1.2, 8.4]), NTproBNP (4.4[1.8,11.0]), CKMB (3.3[1.3, 8.0]), and MMP-2 (4.2[1.5, 11.8]) were significantly associated with subsequent mortality. Conclusions Severe Chagas cardiomyopathy is associated with high short-term mortality. BNP, NTproBNP, CKMB and MMP2 have added predictive value for mortality, even in the presence of decreased ejection fraction and other clinical signs of congestive heart failure.

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Outcome of Chagas cardiomyopathy in comparison to ischemic cardiomyopathy

Cited by 39 publications

References 42 publications

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

The treatment of chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

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