Chagas disease is associated with a poor outcome at 1-year follow-up after cardiac resynchronization therapy
Luiz Carlos Santana Passos1, Rodrigo Morel Vieira de Melo1, Yasmin Menezes Lira1
1Hospital Ana Nery, Universidade Federal da Bahia, Salvador, BA, Brasil.
Insights
Cardiac resynchronization therapy (CRT) improves outcomes for heart failure (HF) patients. However, Chagas
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Research
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure (HF).
- Clinical trials often underrepresent patients with Chagas' disease (CD), an endemic cause of HF in certain regions.
- Limited data exists on CRT effectiveness in HF patients with Chagas' disease.
Purpose of the Study:
- To assess the prognosis of heart failure patients undergoing CRT, specifically evaluating the impact of Chagas' disease.
- To identify predictors of adverse events (death or HF hospitalization) within one year post-CRT in this population.
Main Methods:
- Retrospective cohort study of 54 heart failure patients with LVEF < 35% receiving CRT between 2015-2016.
- Collected clinical and demographic data to analyze predictors of a combined endpoint: all-cause mortality or HF hospitalization.
- Compared outcomes between patients with Chagas' disease and other HF etiologies.
Main Results:
- Chagas' disease was the etiology in 13 (24.1%) of the 54 patients.
- The combined endpoint occurred in 17 (32.1%) patients after a mean follow-up of 15 months.
- Univariate and multivariate analyses identified Chagas' disease (RR: 3.91) and lower LVEF as independent risk factors for adverse outcomes.
Conclusions:
- In heart failure patients receiving CRT, Chagas' disease is independently associated with increased mortality and hospitalization.
- These findings highlight the importance of considering Chagas' disease in the management and risk stratification of HF patients undergoing CRT.
Background:
Cardiac resynchronization therapy (CRT) is a therapeutic modality for patients with heart failure (HF). The effectiveness of this treatment for event reduction is based on clinical trials where the population of patients with Chagas' disease (DC) is underrepresented.
Objective:
To evaluate the prognosis after CRT of a population in which CD is an endemic cause of HF.
Methods:
A retrospective cohort conducted between January 2015 and December 2016 that included patients with HF and left ventricular ejection fraction (LVEF) of less than 35% and undergoing CRT. Clinical and demographic data were collected to search for predictors for the combined outcome of death or hospitalization for HF at one year after CRT implantation.
Results:
Fifty-four patients were evaluated, and 13 (24.1%) presented CD as the etiology of HF. The mean LVEF was 26.2± 6.1%, and 36 (66.7%) patients presented functional class III or IV HF. After the mean follow-up of 15 (±6,9) months, 17 (32.1%) patients presented the combined outcome. In the univariate analysis, CD was associated with the combined event when compared to other etiologies of HF, 8 (47%) vs. 9 (13,5%), RR: 3,91 CI: 1,46-10,45, p=0,007, as well as lower values of LVEF. In the multivariate analysis, CD and LVEF remained independent risk factors for the combined outcome.
Conclusion:
In a population of HF patients undergoing CRT, CD was independently associated with mortality and hospitalization for HF.
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