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J Am Soc Echocardiogr. 2019 Feb;32(2):286-295.e3. doi: 10.1016/j.echo.2018.09.006. Epub 2018 Nov 9.

Effects of Trypanocidal Treatment on Echocardiographic Parameters in Chagas Cardiomyopathy and Prognostic Value of Wall Motion Score Index: A BENEFIT Trial Echocardiographic Substudy.

Author information

1
Cardiology Division, Internal Medicine Department, Medical School of Ribeirão Preto, Ribeirão Preto, Brazil. Electronic address: aschmidt@fmrp.usp.br.
2
Cardiology Division, Internal Medicine Department, Medical School of Ribeirão Preto, Ribeirão Preto, Brazil.
3
Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
4
Hospital do Coração Anis Rassi, Goiânia, Brazil.
5
Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
6
Hospital Eduardo Eguia, Programa Chagas, Tupiza, Bolivia.
7
Instituto Nacional de Parasitologia Dr. Mario Fatala Chaben-Administración Nacional de Laboratórios e Institutos de Salud, CONICET, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina.
8
Hospital Nacional Rosales, San Salvador, El Salvador.

Abstract

BACKGROUND:

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 substudy 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.

KEYWORDS:

Chagas cardiomyopathy; Echocardiography; Prognosis; Trypanocidal therapy

PMID:
30420161
DOI:
10.1016/j.echo.2018.09.006

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