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

Abstract

<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>

Prognostic Significance of Chronic Kidney Disease (CKD-EPI Equation) and Anemia in Patients with Chronic Heart Failure Secondary to Chagas Cardiomyopathy

“…Regarding the use of ICD, we believe that the main reason for this finding is the prevention of sudden cardiac death due to life-threatening ventricular arrhythmias, common clinical complication in patients with severe CHF secondary to CC [4,36]. Furthermore, as previously demonstrated by our group, hyponatremia is an independent predictor of all-cause mortality for this population [37] and may appear as a consequence of marked activation of the renin-angiotensin-aldosterone and autonomic nervous systems, which ultimately determines myocyte death, reparative fibrosis, and ventricular remodeling [38,39]. In this context, maybe is prudent to avoid hyponatremia to counteract the deleterious effect of activation of the involved systems.…”

Management of Cardiovascular Disease in Patients With COVID-19 and Chronic Chagas Disease: Implications to Prevent a Scourge Still Larger

“…Reversion of the ventricular remodeling can occur in patients with CHF secondary to CCHD, but its significance on the prognosis of such patients is unknown ( 52 ). About 39% of patients with this condition do not tolerate the association of beta-blockers with angiotensin converting enzyme inhibitors/angiotensin receptor blocks at targeted doses because of symptomatic systemic arterial hypotension ( 53 ). This fact can also account for the unfavorable outcome of such patients.…”

Chagas Disease: Where to now?

“…12 They describe how CHF affects about half patients with Chagas cardiomyopathy, with an annual mortality approaching 20%, higher than that observed in non-Chagas Disease heart failure. As no randomized trial has been conducted in patients with Chagas cardiomyopathy with CHF, treatment relies on evidence obtained in non-Chagas Disease heart failure.…”