Why do patients with chagasic cardiomyopathy have worse outcomes than those with non-chagasic cardiomyopathy?
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).
Silva
Christiano Pereira
CP
Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil. chrispsilva@hotmail.com
Del Carlo
Carlo Henrique
CH
Oliveira Junior
Mucio Tavares de
MT
Scipioni
Airton
A
Strunz-Cassaro
Celia
C
Ramirez
José Antonio Franchini
JA
Pereira Barretto
Antonio Carlos
AC
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
D014409:Tumor Necrosis Factor-alpha; D012964:Sodium