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A cohort study of cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy

Martino Martinelli Filho1, Giselle de Lima Peixoto1, Sérgio Freitas de Siqueira1

  • 1Heart Institute (InCor), University of São Paulo Medical School, Av. Enéas de Carvalho Aguiar, São Paulo, SP, Brazil.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|March 7, 2018
PubMed

Insights

Cardiac resynchronization therapy (CRT) offers limited benefits for patients with chronic Chagas cardiomyopathy (CCC). CCC patients experienced higher mortality and poorer outcomes post-CRT compared to those with dilated or ischemic cardiomyopathy.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Infectious Diseases

Background:

  • Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure.
  • Previous CRT efficacy trials excluded patients with chronic Chagas cardiomyopathy (CCC).
  • The effectiveness of CRT in CCC patients remains under-evaluated.

Purpose of the Study:

  • To assess the outcomes of CRT in patients with chronic Chagas cardiomyopathy.
  • To compare CRT efficacy in CCC patients versus those with dilated (DCM) and ischemic (ICM) cardiomyopathies.

Main Methods:

  • Retrospective study comparing outcomes of 115 CCC patients with 177 DCM and 134 ICM patients undergoing CRT.
  • Primary endpoint: all-cause mortality.
  • Secondary endpoints: NYHA class at 12 months and echocardiographic changes at 6 months post-CRT.

Main Results:

  • CCC patients had significantly higher annual mortality rates (25.4%) compared to DCM (10.4%) and ICM (11.3%) groups.
  • Multivariate analysis revealed a 2.34-fold higher risk of death in CCC patients versus DCM patients.
  • Fewer CCC patients achieved non-advanced NYHA class (56.5%) compared to DCM (74.0%) and ICM (73.9%) groups; echocardiographic improvements were limited in CCC and ICM groups.

Conclusions:

  • Patients with chronic Chagas cardiomyopathy undergoing CRT exhibit a worse prognosis than those with DCM or ICM.
  • Further studies are needed to compare outcomes of CCC patients with and without CRT.
  • The findings highlight a potential disparity in CRT benefits across different cardiomyopathy etiologies.
Abstract

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