Outcome of Chagas cardiomyopathy in comparison to ischemic cardiomyopathy

BackgroundChagas cardiomyopathy and ischemic heart disease (IHD) are frequent causes of chronic systolic heart failure (CHF) in areas where the former is endemic. Nonetheless, a specific comparison of outcome and role of etiology of CHF failure has not been performed in patients with both conditions.MethodsTwo-hundred twenty two patients with Chagas cardiomyopathy and 79 with IHD with CHF were included in the study. A Cox proportional hazards model was used to establish independent predictors of mortality for the studied population. Survival analysis was performed with the Kaplan-Meir product limit method.ResultsIn the multivariable model, Beta-Blocker therapy [(hazard ratio (HR) = 0.36; 95% confidence interval (CI) 0.24 to 0.52; p < 0.005)], Chagas etiology of CHF (HR = 3.6; 95% CI 2.0 to 6.5; p < 0.005), serum sodium levels (HR = 0.95; 95% CI 0.91 to 0.98; p < 0.005), digoxin use (HR = 2.1; 95% CI 1.19 to 3.80, p = 0.01), and spironolactone use (HR = 1.7; 95% CI 1.10 to 2.80; p = 0.02) were determined independent predictors of all-cause mortality for this cohort. Probability of survival at 12, 24, 36, 48, and 60 months was 92%, 92%, 88%, 81%, and 78%, respectively, in IHD patients, and 79%, 61%, 49%, 41%, and 35%, respectively, in Chagas cardiomyopathy patients (p < 0.005).ConclusionOutcome in patients with chronic systolic heart failure secondary to Chagas cardiomyopathy is poorer than that seen in those with IHD.