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Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy.
Circ Heart Fail. 2017 Nov; 10(11)CH

Abstract

BACKGROUND

Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies.

METHODS AND RESULTS

This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; P=0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; P=0.002). The rates of all-cause mortality were also higher.

CONCLUSIONS

Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies.

CLINICAL TRIAL REGISTRATION

PARADIGM-HF: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00853658.

Authors+Show Affiliations

From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.). john.mcmurray@glasgow.ac.uk.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29141857

Citation

Shen, Li, et al. "Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy." Circulation. Heart Failure, vol. 10, no. 11, 2017.
Shen L, Ramires F, Martinez F, et al. Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy. Circ Heart Fail. 2017;10(11).
Shen, L., Ramires, F., Martinez, F., Bodanese, L. C., Echeverría, L. E., Gómez, E. A., Abraham, W. T., Dickstein, K., Køber, L., Packer, M., Rouleau, J. L., Solomon, S. D., Swedberg, K., Zile, M. R., Jhund, P. S., Gimpelewicz, C. R., & McMurray, J. J. V. (2017). Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy. Circulation. Heart Failure, 10(11). https://doi.org/10.1161/CIRCHEARTFAILURE.117.004361
Shen L, et al. Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy. Circ Heart Fail. 2017;10(11) PubMed PMID: 29141857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy. AU - Shen,Li, AU - Ramires,Felix, AU - Martinez,Felipe, AU - Bodanese,Luiz Carlos, AU - Echeverría,Luis Eduardo, AU - Gómez,Efraín A, AU - Abraham,William T, AU - Dickstein,Kenneth, AU - Køber,Lars, AU - Packer,Milton, AU - Rouleau,Jean L, AU - Solomon,Scott D, AU - Swedberg,Karl, AU - Zile,Michael R, AU - Jhund,Pardeep S, AU - Gimpelewicz,Claudio R, AU - McMurray,John J V, AU - ,, PY - 2017/06/26/received PY - 2017/10/11/accepted PY - 2017/11/17/entrez PY - 2017/11/17/pubmed PY - 2017/12/5/medline KW - Latin America KW - Trypanosoma cruzi KW - heart failure KW - hospitalization KW - mortality JF - Circulation. Heart failure JO - Circ Heart Fail VL - 10 IS - 11 N2 - BACKGROUND: Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies. METHODS AND RESULTS: This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; P=0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; P=0.002). The rates of all-cause mortality were also higher. CONCLUSIONS: Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies. CLINICAL TRIAL REGISTRATION: PARADIGM-HF: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00853658. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/29141857/Contemporary_Characteristics_and_Outcomes_in_Chagasic_Heart_Failure_Compared_With_Other_Nonischemic_and_Ischemic_Cardiomyopathy_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.117.004361?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -