Comparação do desfecho entre a cardiopatia chagásica e a miocardiopatia dilatada idiopática / Comparison of outcome between Chagas cardiomyopathy and idiopathic dilated cardiomyopathy

FUNDAMENTO: Pouco se sabe sobre o desfecho dos pacientes com cardiopatia chagásica, em comparação aos pacientes com miocardiopatia dilatada idiopática na era contemporânea. OBJETIVO: Comparar o desfecho dos pacientes chagásicos com insuficiência cardíaca sistólica crônica decorrente da cardiopatia chagásica ao observado em pacientes com MDI na era contemporânea. MÉTODOS: Foi incluído um total de 352 pacientes (246 com cardiomiopatia chagásica e 106 com miocardiopatia dilatada idiopática), seguidos prospectivamente em nossa Instituição, de janeiro de 2000 a janeiro de 2008. Todos os pacientes receberam tratamento clínico contemporâneo padrão. RESULTADOS: Na análise multivariada com o modelo de risco proporcional de Cox, o uso da digoxina (relação de risco = 3,17; intervalo de confiança de 95 por cento, de 1,62 a 6,18; p = 0,001) necessitou de suporte inotrópico (relação de risco = 2,08; intervalo de confiança de 95 por cento, de 1,43 a 3,02; p < 0,005). A fração de ejeção do ventrículo esquerdo (relação de risco = 0,97; intervalo de confiança de 95 por cento, de 0,95 a 0,99; p < 0,005) e a etiologia da cardiopatia chagásica (relação de risco = 3,29; intervalo de confiança de 95 por cento, de 1,89 a 5,73; p < 0,005) foram associadas positivamente à mortalidade, enquanto a terapia com betabloqueadores (relação de risco = 0,39; intervalo de confiança de 95 por cento, de 0,26 a 0,56; p < 0,005) foi associada negativamente à mortalidade. A probabilidade de sobrevida para pacientes com cardiomiopatia chagásica em oito, 24 e 49 meses foi de 83 por cento, 61 por cento e 41 por cento, respectivamente. Já para pacientes com cardiomiopatia dilatada idiopática, foi de 97 por cento, 92 por cento e 82 por cento, respectivamente (p < 0,005). CONCLUSÃO: Na era atual do tratamento da insuficiência cardíaca, os pacientes com cardiomiopatia chagásica têm um desfecho pior em comparação aos pacientes com cardiomiopatia dilatada idiopática.

BACKGROUND: Little is known about the outcome of patients with Chagas cardiomyopathy in comparison to that of patients with Idiopathic Dilated Cardiomyopathy in the contemporary era. OBJECTIVE: To compare the outcome of chagasic patients with chronic systolic heart failure secondary to Chagas cardiomyopathy with that observed in patients with IDC in the contemporary era. METHODS: A total of 352 patients (246 with Chagas cardiomyopathy, 106 with Idiopathic Dilated Cardiomyopathy) prospectively followed at our Institution from January, 2000 to January, 2008 were included. All patients received standard contemporary medical therapy. RESULTS: In Cox proportional hazards model multivariate analysis, digoxin use (Hazard Ratio=3.17; 95 percent Confidence Interval 1.62 to 6.18; p=0.001), need of inotropic support (Hazard Ratio=2.08; 95 percent Confidence Interval 1.43 to 3.02; p<0.005), left ventricular ejection fraction (Hazard Ratio=0.97; 95 percent Confidence Interval 0.95 to 0.99; p<0.005), and Chagas cardiomyopathy etiology (Hazard Ratio=3.29; 95 percent Confidence Interval 1.89 to 5.73; p<0.005) were positively associated with mortality, whereas Beta-Blocker therapy (Hazard Ratio=0.39; 95 percent Confidence Interval 0.26 to 0.56; p<0.005) was negatively associated with mortality. Survival probability for patients with Chagas cardiomyopathy at 8, 24, and 49 months was 83 percent, 61 percent, and 41 percent, respectively, and for patients with Idiopathic Dilated cardiomyopathy 97 percent, 92 percent, and 82 percent, respectively (p<0.005). CONCLUSION: In the current era of heart failure therapy, patients with Chagas cardiomyopathy have a poorer outcome in comparison to patients with Idiopathic Dilated Cardiomyopathy.

Comparison of outcome between Chagas cardiomyopathy and idiopathic dilated cardiomyopathy.

BACKGROUND: Little is known about the outcome of patients with Chagas cardiomyopathy in comparison to that of patients with idiopathic dilated cardiomyopathy in the contemporary era. OBJECTIVE: To compare the outcome of chagasic patients with chronic systolic heart failure secondary to Chagas cardiomyopathy with that observed in patients with IDC in the contemporary era. METHODS: A total of 352 patients (246 with Chagas cardiomyopathy, 106 with idiopathic dilated cardiomyopathy) prospectively followed at our Institution from January, 2000 to January, 2008 were included. All patients received standard contemporary medical therapy. RESULTS: In Cox proportional hazards model multivariate analysis, digoxin use (Hazard Ratio=3.17; 95% Confidence Interval 1.62 to 6.18; p=0.001), need of inotropic support (Hazard Ratio=2.08; 95% Confidence Interval 1.43 to 3.02; p<0.005), left ventricular ejection fraction (Hazard Ratio=0.97; 95% Confidence Interval 0.95 to 0.99; p<0.005), and Chagas cardiomyopathy etiology (Hazard Ratio=3.29; 95% Confidence Interval 1.89 to 5.73; p<0.005) were positively associated with mortality, whereas beta-blocker therapy (Hazard Ratio=0.39; 95% Confidence Interval 0.26 to 0.56; p<0.005) was negatively associated with mortality. Survival probability for patients with Chagas cardiomyopathy at 8, 24, and 49 months was 83%, 61%, and 41%, respectively, and for patients with idiopathic dilated cardiomyopathy 97%, 92%, and 82%, respectively (p<0.005). CONCLUSION: In the current era of heart failure therapy, patients with Chagas cardiomyopathy have a poorer outcome in comparison to patients with idiopathic dilated cardiomyopathy.

Prognostic significance of anemia in patients with chronic systolic heart failure secondary to Chagas' cardiomyopathy.

The purpose of this study was to evaluate the prognostic significance of anemia on outcome of patients with chronic systolic heart failure secondary to Chagas' cardiomyopathy, as no previous study has previously addressed this question. One-hundred-eight-six patients followed for chronic systolic heart failure secondary to Chagas' cardiomyopathy at our Institution from January 2000 to December 2008 were studied. Forty-nine (26%) patients were found to have anemia; 37 (20%) were men and 12 (6%) were women. Mean hemoglobin level was 14.1±1.2g/L in patients with no anemia and 11.5±1.2g/L in patients with anemia. On a Cox proportional hazards multivariate analysis, anemia was a predictor of all-cause mortality neither in the univariate nor in the multivariate analysis. Mean serum sodium (Hazard ratio=0.92; Beta-coefficient=-0.09; 95% confidence interval 0.89-0.96; p value<0.005), and Beta-Blocker therapy (Hazard ratio=0.40; 95% confidence interval 0.26-0.61; p value<0.005) were retained as independent predictors of mortality for patients with Chagas' cardiomyopathy with chronic heart failure. Probability of survival for patients with anemia, however, was significantly lower in patients with anemia in comparison to patients with no anemia, mainly in patients with advanced heart failure. Anemia is not an independent predictor of all-cause mortality in patients with Chagas' cardiomyopathy with chronic systolic heart failure. Probability of survival is poorer in patients with anemia than in those without.

Effects of B-Blockers on outcome of patients with Chagas' cardiomyopathy with chronic heart failure.

BACKGROUND: A few studies have shown a beneficial effect of B-Blocker therapy on cardiac function and functional status in patients with chronic heart failure secondary to Chagas' cardiomyopathy. METHODS: The medical charts of patients routinely followed from January, 2000 to January, 2007 were reviewed to collect clinical, standard laboratory tests, 12-lead electrocardiogram, chest X-Ray, and Doppler echochardiogram variables. A Cox proportional hazards model was used to establish independent predictors of all-cause mortality for patients with Chagas' cardiomyopathy with chronic heart failure. RESULTS: A total of 231 consecutive patients were enrolled in the study. Median follow up was 19 (7, 46) months. Twenty (9%) patients underwent heart transplantation and 120 (52%) died during the investigation. Left ventricular systolic dimension (hazard ratio=1.04; 95% confidence interval=1.02 to 1.06; p<0.005) and need of inotropic support (hazard ratio=1.80; 95% confidence interval 1.2 to 2.60; p=0,03), were positively associated, whereas B-Blocker therapy (HR=0.34; 95% confidence interval 0.23 to 0.51; p<0.0005) was negatively associated with mortality. Mortality was significantly lower in patients taking in comparison to those not taking B-Blockers. Patients taking a mean daily dose of carvedilol>or=to 9.375mg had a marked decrease in mortality in comparison to those not on carvedilol therapy. CONCLUSION: B-Blockers are effective, not detrimental, and may improve survival in Chagas' disease patients with chronic heart failure. A randomized trial is necessary to confirm these findings.