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Prognostic value of soluble TNF receptors in Chagas cardiomyopathy: observational study
Matheus Ribeiro Ávila1, Daniel Menezes de Souza2, Lucas Fróis Fernandes de Oliveira1
1Universidade Federal dos Vales do Jequitinhonha e Mucuri, Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil.
Insights
High serum levels of soluble tumor necrosis factor receptor 2 (sTNFR2) and lower left ventricular ejection fraction (LVEF) predict adverse cardiovascular events in Chronic Chagas cardiomyopathy (CCC), aiding risk stratification.
Area of Science:
- Cardiology
- Immunology
- Chagas Disease Research
Background:
- Chronic Chagas cardiomyopathy (CCC) is a severe manifestation of Chagas disease.
- Elevated soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2) correlate with cardiac parameters in CCC.
- The prognostic significance of sTNFR1 and sTNFR2 in CCC remains undetermined.
Purpose of the Study:
- To ascertain the prognostic value of serum sTNFR1 and sTNFR2 levels in patients with CCC.
- To identify biomarkers for predicting adverse cardiovascular events in CCC.
Main Methods:
- A longitudinal study involving 69 CCC patients (NYHA I-II) was conducted.
- Patients underwent blood collection for sTNFR1/sTNFR2 measurement and echocardiography.
- Follow-up duration was approximately 43.8 months, with outcomes defined as cardiac death, heart transplantation, or stroke.
Main Results:
- Fifteen patients (22%) experienced adverse cardiovascular events during follow-up.
- Left ventricular ejection fraction (LVEF) and serum sTNFR2 levels were independent predictors of these events.
- An sTNFR2 level of 1784.00 pg/mL served as an optimal cutoff, significantly differentiating event risk.
Conclusions:
- Elevated serum sTNFR2 levels, alongside reduced LVEF, are potent independent predictors of adverse cardiovascular events in CCC.
- These biomarkers offer significant value for risk stratification in CCC patients.
- sTNFR2 may play a crucial role in the pathogenesis and prognosis of CCC.
Background:
Chronic Chagas cardiomyopathy (CCC) is the most severe clinical form of the Chagas disease. There is a strong correlation between soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2) and cardiac and functional parameters in CCC, but their prognostic value remains unknown.
Objective:
To verify the prognostic value of sTNFR1 and sTNFR2 in CCC.
Methods:
A longitudinal study was conducted. Sixty-nine patients with CCC (53.70 ± 9.66 years, NYHA I-II) were submitted to blood collection and echocardiography, and followed for 43.81 ± 1.21 months. The outcome was determined by the combination of cardiac death, heart transplantation, or stroke.
Findings:
After the follow-up, 15 patients (22%) presented adverse cardiovascular events. Only left ventricular ejection fraction (LVEF) [heart rate at rest (HR): 0.935, 95% CI 0.878 to 0.994; p = 0.033] and sTNFR2 (HR: 1.002, 95% CI 1.001 to 1.003; p = 0.006) remained as independent predictors of adverse cardiovascular events. The optimal cutoff point to identify these patients was the value of 1784.00 pg/mL. There was a significant difference between the groups with lower and higher sTNFR2 levels (long-rank < 0.001).
Main Conclusions:
High serum levels of sTNFR2, together with lower LVEF, are strong independent predictors of adverse cardiovascular events in CCC, making them valuable for risk stratification.
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