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Left ventricular reverse remodeling: A predictor of survival in chagasic cardiomyopathy patients with a reduced

Maria Tereza Sampaio de Sousa Lira1, Silas Ramos Furquim1, Daniel Catto de Marchi1

  • 1Instituto do Coração (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil.

Plos Neglected Tropical Diseases
|April 23, 2025
PubMed

Insights

Left ventricular reverse remodeling (LVRR) improves survival in patients with chronic Chagasic cardiomyopathy (CCC) and heart failure. Early identification and therapies promoting LVRR can reduce mortality in this population.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Chagas disease is a growing global health concern, particularly in Latin America.
  • Chronic Chagasic cardiomyopathy (CCC) is a severe complication leading to heart failure with reduced ejection fraction (HFrEF).
  • Left ventricular reverse remodeling (LVRR), characterized by improved ejection fraction, is linked to better outcomes in HFrEF from various causes.

Purpose of the Study:

  • To investigate the association between LVRR and survival rates in CCC patients with an LVEF below 40%.
  • To identify predictors of mortality and the need for heart transplantation in this patient group.

Main Methods:

  • Retrospective, single-center study of 1,043 CCC patients with LVEF < 40% (2006-2021).
  • Patients categorized into positive (PRR) or negative (NRR) reverse remodeling groups based on LVEF changes.
  • Propensity score matching and Cox proportional hazards models used to analyze outcomes and predictors.

Main Results:

  • 21.2% of patients achieved PRR. PRR was associated with a 55% lower risk of mortality and heart transplantation over 15 years (p=0.002).
  • Independent predictors of mortality/transplantation included NRR status, worse NYHA class, lower sodium, larger LV dimensions, and moderate-to-severe tricuspid regurgitation.
  • PRR predictors included smaller LV dimensions, less mitral regurgitation, and absence of triple therapy at baseline.

Conclusions:

  • Positive reverse remodeling significantly enhances survival in CCC patients with HFrEF.
  • Identifying patients amenable to LVRR and implementing early interventions are crucial for reducing mortality.
  • Future research should explore therapies specifically designed to promote LVRR in CCC.
Abstract

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