ABSTRACT
BACKGROUND:The role of trypanocidal therapy in patients with established Chagas' cardiomyopathy is unproven.METHODS:We conducted a prospective, multicenter, randomized study involving 2854 patients with Chagas' cardiomyopathy who received benznidazole or placebo for up to 80 days and were followed for a mean of 5.4 years. The primary outcome in the time-to-event analysis was the first event of any of the components of the composite outcome of death, resuscitated cardiac arrest, sustained ventricular tachycardia, insertion of a pacemaker or implantable cardioverter-defibrillator, cardiac transplantation, new heart failure, stroke, or other thromboembolic event.RESULTS:The primary outcome occurred in 394 patients (27.5%) in the benznidazole group and in 414 (29.1%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.81 to 1.07; P=0.31). At baseline, a polymerase-chain-reaction (PCR) assay was performed on blood samples obtained from 1896 patients; 60.5% had positive results for Trypanosoma cruzi on PCR. The rates of conversion to negative PCR results (PCR conversion) were 66.2% in the benznidazole group and 33.5% in the placebo group at the end of treatment, 55.4% and 35.3%, respectively, at 2 years, and 46.7% and 33.1%, respectively, at 5 years or more (P<0.001 for all comparisons)...
Subject(s)
Chagas Cardiomyopathy , Chagas DiseaseABSTRACT
Patients in the chronic phase of Chagas' disease and receiving corticoid because of concommitant diseases were treated with benznidazole, which was initiated at the same time of the use of corticoid in a group of 12 patients or 15 days afterwards in 6 patients. It has been proved in another paper that in the chronic phase of Chagas' disease corticoid use is associated with increased parasitemia, as evaluated by xenodiagnosis. In this study benznidazole use prevented this increase, and we suggest that in immunocompromised patients with chronic Chagas' disease the use of this drug could be useful.
Subject(s)
Chagas Disease/drug therapy , Glucocorticoids/pharmacology , Nitroimidazoles/therapeutic use , Trypanocidal Agents/therapeutic use , Trypanosoma/drug effects , Adolescent , Adult , Animals , Chagas Disease/complications , Chronic Disease , Female , Glucocorticoids/adverse effects , Humans , Male , Middle Aged , Trypanosoma/growth & developmentABSTRACT
A taquicardia por reentrada nodal (TRN) corresponde, aproximadamente, 50 a 70 por cento dos tipos de taquicardia paroxística supraventricular (TPSV). Existe certa prevalência favorável ao sexo feminino e em menores de 40 anos de idade. A frequência cardíaca (FC), durante o paroxismo taquicárdico, pode oscilar de 100 a 280bpm, com valores médios em torno de 170bpm. A arquitetura complexa do nódulo atrioventricular (NAV), com sua característica de anisotropia tissular e heterogeneidade de conduçäo dompulso elétrico, com dissociaçäo longitudinal, levando ao chamado comportamento dual de conduçäo atrioventricular (AV) ou ventrículo-atrial, predispöes ao microcircuito de reentrada intranodal -base fisiopatológica da TRN. A seguir, as características eletrofisiológicas da estrutura do sistema de conduçäo, desde aspectos eletrofisiológicos até modalidades de abordagem terapêutica, visando o esclarecimento do mecanismo da taquicardia e o procedimento técnico utilizado para sua erradiaçäo.
