title: Why do patients with chagasic cardiomyopathy have worse outcomes than those with non-chagasic cardiomyopathy?
abstract: BACKGROUND
  Heart failure is a highly prevalent disease, the prognosis of which depends on different predictive factors.
  
  
  OBJECTIVE
  Chagas disease is a predictor of poor prognosis in patients with chronic heart failure (HF). The purpose of this study is to investigate whether this condition also predicts poor outcome in acutely decompensated patients.
  
  
  METHODS
  Four hundred and seventeen patients admitted for decompensated heart failure were studied. Mean age was 51.8 years, and 291 (69.8%) were male. They were divided into two groups: 133 (31.9%) patients with Chagas heart disease (CH) and 284 patients with heart failure of other etiologies. Cytokine and norepinephrine plasma levels were measured in a subgroup of 63 patients (15.1% with Chagas disease).
  
  
  RESULTS
  At admission, 24.6% of the patients needed inotropic support, and one-year mortality was 54.7%. Mortality rates were higher in the CH group (69.2% vs. 47.9%, p < 0.001). When data were compared, patients with Chagas disease were younger (47.6 vs. 53.8 years, p < 0.001) and, on average, showed lower systolic blood pressure (96.7 vs. 111.2 mmHg, p < 0,001), ejection fraction (32.7 vs. 36.4%, p < 0.001), and serum Na (134.6 vs. 136.0, p = 0.026), in addition to higher TNF-alpha levels (33.3 vs. 14.8, p = 0.001). The presence of hypotension requiring inotropic support, left ventricular (LV) diastolic diameter, renal function findings, and interleukin-6 and norepinephrine plasma levels did not differ between both groups.
  
  
  CONCLUSIONS
  Chagas disease patients admitted with decompensated heart failure had worse prognoses than patients with heart failure of other etiologies. This may be owing to a greater degree of cardiac impairment (lower ejection fraction) and hemodynamic instability (lower systolic blood pressure and heart rate), increased activation of the renin-angiotensin system (lower sodium), and increased cytokine levels (TNF-alpha).
authors.affiliation: Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil. chrispsilva@hotmail.com
authors.forename: Christiano Pereira
authors.initials: CP
authors.lastname: Silva
authors.forename: Carlo Henrique
authors.initials: CH
authors.lastname: Del Carlo
authors.forename: Mucio Tavares de
authors.initials: MT
authors.lastname: Oliveira Junior
authors.forename: Airton
authors.initials: A
authors.lastname: Scipioni
authors.forename: Celia
authors.initials: C
authors.lastname: Strunz-Cassaro
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramirez
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Pereira Barretto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D002598:Chagas Cardiomyopathy / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012964:Sodium / Q000097:blood; D013318:Stroke Volume / Q000502:physiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha; D012964:Sodium