Comparative Prognosis of Chagas and Other Cardiomyopathies

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Chagas disease, caused by Trypanosoma cruzi, is a significant cause of heart failure (HF) in Latin America and is now endemic in the USA.
• Heart failure with reduced ejection fraction (HFrEF) presents diverse etiologies, impacting patient outcomes differently.

Purpose of the Study:

• To compare the clinical outcomes of HFrEF in patients with Chagasic etiology against other common causes.
• To assess the risks of mortality and stroke in Chagasic HFrEF relative to ischemic and other non-ischemic HFrEF.

Main Methods:

• Analysis of investigator-reported HFrEF etiologies (ischemic, valvular, alcoholic, hypertensive, idiopathic, viral, Chagasic, other) from ATMOSPHERE, PARADIGM-HF, and GALACTIC-HF trials.
• Utilized Cox models to analyze time to composite outcomes (HF hospitalization or cardiovascular death), individual components, all-cause death, and stroke, adjusting for baseline characteristics and trial specifics.

Main Results:

• Chagasic HF demonstrated the highest incidence rates for all clinical outcomes among the studied etiologies.
• Compared to ischemic HF, Chagasic HFrEF showed significantly higher adjusted hazard ratios for the composite outcome (1.65), HF hospitalization (1.75), cardiovascular death (1.86), all-cause death (1.82), and stroke (2.16).

Conclusions:

• Patients with Chagasic HFrEF experience a distinct clinical trajectory characterized by increased mortality and a heightened risk of stroke.
• These findings underscore the importance of recognizing Chagasic etiology in HFrEF management, particularly in endemic regions and the USA.