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Comparative Prognosis of Chagas and Other Cardiomyopathies

Ryohei Ono1, Kieran F Docherty1, Alasdair D Henderson1

  • 1British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.

Journal of the American College of Cardiology
|March 18, 2026
PubMed

Insights

Chagasic heart failure (HF) patients face higher risks of death and stroke compared to those with ischemic HF. This study highlights the distinct clinical course of Chagasic heart failure with reduced ejection fraction (HFrEF).

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.
Abstract

Keywords:
ChagasHFrEFclinical outcomesetiologyheart failure with reduced ejection fractionnonischemic

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