Effects of trypanocidal treatment on echocardiographic parameters in chagas cardiomyopathy and prognostic value of wall motion score index: A BENEFIT trial echocardiographic substudy
J. Am. Soc. Echocardiogr
; 32(2): 286-295, Fev. 2019. tabela, gráfico
Artigo
em Inglês
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1023938
Biblioteca responsável:
BR79.1
Localização: BR79.1
ABSTRACT
Serial echocardiographic studies in chronic Chagas cardiomyopathy are scarce. The aims of this study were to evaluate whether therapy with benznidazole modifies the progression of cardiac impairment and to identify baseline echocardiographic parameters related to prognosis. METHODS:
A prospective sub study was conducted in 1,508 patients with chronic Chagas cardiomyopathy randomized to benznidazole or placebo, who underwent two-dimensional echocardiography at enrollment, 2 years, and final follow-up (5.4 years). Left ventricular (LV) ejection fraction, LV wall motion score index (WMSI), indexed left atrial volume, and chamber dimensions were collected and correlated to all-cause death and a composite hard outcome using univariate and multivariate analyses.RESULTS:
At enrollment, most patients had normal chamber dimensions, and 70.5% had preserved LV ejection fractions. During follow-up, all chamber dimensions increased similarly in both treatment arms. LV ejection fraction was comparably reduced (55.7 ± 12.7% to 52.1 ± 14.6% vs 56.3 ± 12.7% to 52.8 ± 14.1%) and LV WMSI similarly increased (1.31 ± 0.41 to 1.49 ± 0.03 and 1.27 ± 0.38 to 1.51 ± 0.03) for the benznidazole and placebo groups, respectively (P > .05). A higher baseline LV WMSI was identified in subjects who died compared with those alive at final echocardiography (1.76 ± 0.517 vs 1.271 ± 0.393, P < .0001). There was a significant (P < .0001) graded increase in the risk for the composite outcome with worsening LV WMSI (hazard ratios, 2.27 [95% CI, 1.69-3.06] and 6.42 [95% CI, 4.94-8.33]) and also of death (hazard ratios, 2.45 [95% CI, 1.62-3.71] and 8.99 [95% CI, 6.3-12.82]) for 1 < LV WMSI < 1.5 and LV WMSI > 1.5, respectively. Both LV WMSI and indexed left atrial volume remained independent predictors in multivariate analysis.CONCLUSIONS:
Trypanocidal treatment had no effect on echocardiographic progression of chronic Chagas cardiomyopathy over 5.4 years. Despite normal global LV systolic function, regional wall motion abnormalities and indexed left atrial volume identified patients at higher risk for hard adverse clinical outcomes. Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. KEYWORDS Chagas cardiomyopathy; Echocardiography; Prognosis; Trypanocidal therapy. (AU)
Texto completo:
Disponível
Coleções:
Bases de dados nacionais
/
Brasil
Contexto em Saúde:
ODS3 - Saúde e Bem-Estar
/
Doenças Negligenciadas
/
ODS3 - Meta 3.3 Acabar com as doenças tropicais negligenciadas e combater as doenças transmissíveis
/
ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis
Problema de saúde:
Meta 3.3: Acabar com as doenças tropicais negligenciadas e combater as doenças transmissíveis
/
Doença de Chagas
/
Doenças Negligenciadas
/
Doença de Chagas
/
Doença Cardiovascular
/
Outras Doenças Circulatórias
Base de dados:
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Assunto principal:
Prognóstico
/
Tripanossomicidas
/
Ecocardiografia
/
Cardiomiopatia Chagásica
Tipo de estudo:
Ensaio clínico controlado
/
Estudo prognóstico
Limite:
Humanos
Idioma:
Inglês
Revista:
J. Am. Soc. Echocardiogr
Ano de publicação:
2019
Tipo de documento:
Artigo
Instituição/País de afiliação:
Faculdade de Medicina de Ribeirão Preto/BR
/
Hospital Eduardo Eguia Programa Chagas/BO
/
Hospital Nacional Rosales/SV
/
Hospital do Coração Anis Rassi/BR
/
Instituto Dante Pazzanese de Cardiologia/BR
/
Instituto Nacional de Parasitologia Dr Mario Fatala Chaben/AR
/
McMaster University Medical Centre Hamilton Health Sciences/CA
/
Medical School of Ribeirão Preto/BR