Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Li Shen; Felix Ramires; Felipe Martinez; Luiz Carlos Bodanese; Luis Eduardo Echeverría; Efraín A. Gómez; William T. Abraham; Kenneth Dickstein; Lars Køber; Milton Packer; Jean L. Rouleau; Scott D. Solomon; Karl Swedberg; Michael R. Zile; Pardeep S. Jhund; Claudio R. Gimpelewicz; John J.V. McMurray

doi:10.1161/circheartfailure.117.004361

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

Li Shen, Felix Ramires, Felipe Martinez, Luiz Carlos Bodanese, Luis Eduardo Echeverría, Efraín A. Gómez, William T. Abraham, Kenneth Dickstein, Lars Køber, Milton Packer, Jean L. Rouleau, Scott D. Solomon, Karl Swedberg, Michael R. Zile, Pardeep S. Jhund, Claudio R. Gimpelewicz, John J.V. McMurray

Institut for Klinisk Medicin

24 Citationer (Scopus)

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 allcause 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.

Originalsprog	Engelsk
Artikelnummer	e004361
Tidsskrift	Circulation. Heart failure
Vol/bind	10
Udgave nummer	11
Antal sider	11
ISSN	1941-3289
DOI	https://doi.org/10.1161/circheartfailure.117.004361
Status	Udgivet - nov. 2017

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10.1161/circheartfailure.117.004361

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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), [e004361]. https://doi.org/10.1161/circheartfailure.117.004361

Shen, L, Ramires, F, Martinez, F, Bodanese, LC, Echeverría, LE, Gómez, EA, Abraham, WT, Dickstein, K, Køber, L, Packer, M, Rouleau, JL, Solomon, SD, Swedberg, K, Zile, MR, Jhund, PS, Gimpelewicz, CR & McMurray, JJV 2017, 'Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy', Circulation. Heart failure, bind 10, nr. 11, e004361. https://doi.org/10.1161/circheartfailure.117.004361

@article{3ed8b46695644f31bf826a1f851ba1d8,

title = "Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy",

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 allcause 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.",

keywords = "heart failure, hospitalization, Latin America, mortality, Trypanosoma cruzi",

author = "Li Shen and Felix Ramires and Felipe Martinez and Bodanese, {Luiz Carlos} and Echeverr{\'i}a, {Luis Eduardo} and G{\'o}mez, {Efra{\'i}n A.} and Abraham, {William T.} and Kenneth Dickstein and Lars K{\o}ber and Milton Packer and Rouleau, {Jean L.} and Solomon, {Scott D.} and Karl Swedberg and Zile, {Michael R.} and Jhund, {Pardeep S.} and Gimpelewicz, {Claudio R.} and McMurray, {John J.V.}",

year = "2017",

month = nov,

doi = "10.1161/circheartfailure.117.004361",

language = "English",

volume = "10",

journal = "Circulation: Heart Failure",

issn = "1941-3289",

publisher = "Lippincott Williams & Wilkins",

number = "11",

}

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.

PY - 2017/11

Y1 - 2017/11

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 allcause 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.

AB - 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 allcause 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.

KW - heart failure

KW - hospitalization

KW - Latin America

KW - mortality

KW - Trypanosoma cruzi

U2 - 10.1161/circheartfailure.117.004361

DO - 10.1161/circheartfailure.117.004361

M3 - Journal article

C2 - 29141857

AN - SCOPUS:85038019106

SN - 1941-3289

VL - 10

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

IS - 11

M1 - e004361

ER -

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

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