Post hoc analyses of SHIFT and PARADIGM‐HF highlight the importance of chronic Chagas' cardiomyopathy <i>Comment on:</i> “Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial” by Bocchi <i>et al.</i>

Ramires, Felix José Alvarez; Martínez, Felipe A.; Gómez, Efraín Á.; Demacq, Caroline; Gimpelewicz, Claudio; Rouleau, Jean L.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.; Packer, Milton; McMurray, John J.V.

doi:10.1002/ehf2.12355

Cited by 17 publications

(10 citation statements)

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“…Sacubitril/valsartan was associated with a reduced risk of cardiovascular death or heart failure hospitalization compared to enalapril. Noteworthy, this trial was underpowered to establish a strong recommendation for this treatment [ 125 ]. Notwithstanding, it provided some insights regarding the potential benefits which needed to be proved in more specific trials.…”

Section: Current Treatment and Prognosismentioning

confidence: 99%

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

et al. 2021

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Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community’s apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host–parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease’s clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy’s (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.

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Section: Current Treatment and Prognosismentioning

confidence: 99%

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

et al. 2021

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“…Then, beta-blockers and ACE inhibitors were identified as able to improve LV function and declined hospitalization rate and mortality [6]. From the 2000s, studies of patients with HFrEF revealed that ivabradine seemed to be more beneficial in patients under beta-blocker therapy with a resting heart rate > 70 bpm [11]. Pharmacologic treatment of HF is focused on controlling symptoms and reducing risk factors and comorbidities.…”

Section: Reviewmentioning

confidence: 99%

“…Since ivabradine’s approval by the US Food and Drug Administration for use in HF in 2015 and the European Medicines Agency approval in 2012, it remains a third-line therapy in HF. Nevertheless, it is not available in all countries [11]. The number of clinical studies investigating the use of ivabradine is low.…”

Section: Reviewmentioning

confidence: 99%

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Ivabradine in Congestive Heart Failure: Patient Selection and Perspectives

Sattar¹,

Samani²,

Zafrullah³

et al. 2019

Cureus

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Heart failure (HF) is the fourth-most frequent cause of death and remains a challenge for public health. Therapy goals for HF with reduced ejection fraction (HFrEF) are the improvement in the quality of life, prolonged survival, a reduction of signs and symptoms, and the prevention of hospitalization. Angiotensin-converting enzyme inhibitors, beta-blockers, and mineralocorticoid receptor antagonists are the treatments of choice for HFrEF. Although ivabradine is not available in all countries, it is likely a new promising approach to improve outcomes in patients with HFrEF, either alone or with beta-blockers. Here, we review the current knowledge about ivabradine in HFrEF and assess its effect on outcomes in HF.

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“…We still treat patients with HF caused by ChCM empirically with therapies recommended by guidelines and this is another reason to specifically promote more research in ChCM. [10] This article will analyse and discuss Chagas disease and HF, from epidemiology through to the latest treatment and prevention strategies.…”

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confidence: 99%

Chagas Disease and Heart Failure: An Expanding Issue Worldwide

Martínez

Perna

Perrone³

et al. 2019

Eur Cardiol

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Chagas disease, originally a South American endemic health problem, is expanding worldwide because of people migration. Its main impact is on the cardiovascular system, producing myocardial damage that frequently results in heart failure. Pathogenic pathways are mainly related to inmunoinflamatory reactions in the myocardium and, less frequently, in the gastrointestinal tract. The heart usually shows fibrosis, producing dilatation and damage of the electrogenic cardiac system. These changes result in cardiomyopathy with heart failure and frequent cardiac arrhythmias and heart blocks. Diagnosis of the disease must include a lab test to detect the parasite or its immune reactions and the usual techniques to evaluate cardiac function. Therapeutic management of Chagas heart failure does not differ significantly from the most common treatment for dilated cardiomyopathy, with special focus on arrhythmias and several degrees of heart block. Heart transplantation is reserved for end-stage cases. Major international scientific organisations are delivering recommendations for prevention and early diagnosis. This article provides an analysis of epidemiology, prevention, treatment and the relationship between Chagas disease and heart failure.

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Post hoc analyses of SHIFT and PARADIGM‐HF highlight the importance of chronic Chagas' cardiomyopathy Comment on: “Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial” by Bocchi et al.

Cited by 17 publications

References 10 publications

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

Ivabradine in Congestive Heart Failure: Patient Selection and Perspectives

Chagas Disease and Heart Failure: An Expanding Issue Worldwide

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