Outcome of Chagas cardiomyopathy in comparison to ischemic cardiomyopathy
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Published on: May 5, 2020
Luciana G C Vilas Boas1, Reinaldo B Bestetti, Ana Paula Otaviano
1Department of Cardiology and Cardiovascular Surgery, Hospital de Base, São José do Rio Preto, Brazil.
Insights
Patients with chronic systolic heart failure (CHF) due to Chagas cardiomyopathy have poorer outcomes than those with ischemic heart disease (IHD). This study compared mortality predictors and survival rates in these CHF patient groups.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Chagas cardiomyopathy and ischemic heart disease (IHD) are leading causes of chronic systolic heart failure (CHF).
- Limited comparative data exists on outcomes for CHF patients with these distinct etiologies.
Purpose of the Study:
- To compare the outcomes and identify mortality predictors in patients with CHF secondary to Chagas cardiomyopathy versus IHD.
- To analyze survival differences between the two etiological groups.
Main Methods:
- A cohort study included 222 patients with Chagas cardiomyopathy and 79 with IHD-related CHF.
- Cox proportional hazards models and Kaplan-Meier survival analysis were employed to assess mortality predictors and survival rates.
Main Results:
- Chagas etiology (HR=3.6), digoxin use (HR=2.1), and spironolactone use (HR=1.7) were associated with increased mortality.
- Beta-blocker therapy (HR=0.36) and lower serum sodium levels (HR=0.95) were associated with reduced mortality.
- Survival rates at 60 months were significantly lower for Chagas cardiomyopathy patients (35%) compared to IHD patients (78%).
Conclusions:
- Patients with chronic systolic heart failure due to Chagas cardiomyopathy experience significantly poorer outcomes than those with IHD.
- Etiology of CHF is a critical factor influencing patient prognosis and mortality.
Background:
Chagas cardiomyopathy and ischemic heart disease (IHD) are frequent causes of chronic systolic heart failure (CHF) in areas where the former is endemic. Nonetheless, a specific comparison of outcome and role of etiology of CHF failure has not been performed in patients with both conditions.
Methods:
Two-hundred twenty two patients with Chagas cardiomyopathy and 79 with IHD with CHF were included in the study. A Cox proportional hazards model was used to establish independent predictors of mortality for the studied population. Survival analysis was performed with the Kaplan-Meir product limit method.
Results:
In the multivariable model, Beta-Blocker therapy [(hazard ratio (HR)=0.36; 95% confidence interval (CI) 0.24 to 0.52; p<0.005)], Chagas etiology of CHF (HR=3.6; 95% CI 2.0 to 6.5; p<0.005), serum sodium levels (HR=0.95; 95% CI 0.91 to 0.98; p<0.005), digoxin use (HR=2.1; 95% CI 1.19 to 3.80, p=0.01), and spironolactone use (HR=1.7; 95% CI 1.10 to 2.80; p=0.02) were determined independent predictors of all-cause mortality for this cohort. Probability of survival at 12, 24, 36, 48, and 60 months was 92%, 92%, 88%, 81%, and 78%, respectively, in IHD patients, and 79%, 61%, 49%, 41%, and 35%, respectively, in Chagas cardiomyopathy patients (p<0.005).
Conclusion:
Outcome in patients with chronic systolic heart failure secondary to Chagas cardiomyopathy is poorer than that seen in those with IHD.
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