A cohort study of cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy

Filho, Martino Martinelli; Peixoto, Giselle de Lima; Siqueira, Sérgio; Martins, Sérgio Augusto Mezzalira; Nishioka, Silvana; Pedrosa, Anísio; Teixeira, Ricardo Alkmim; Santos, Johnny Xavier Dos; Costa, Roberto; Filho, Roberto Kalil; Ramires, José Antônio Franchini

doi:10.1093/europace/eux375

Cited by 17 publications

(14 citation statements)

References 16 publications

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“…revealed a broad range of all‐cause AMRs of 3.6%, 9.1%, and 25.4%, respectively. 34 , 37 , 39 Similar to the RCTs, these studies had differences in NYHA functional classification and LVEF, accounting for variations in mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…showed annual all‐cause death rates of 10.4%, 11.3%, and 25.4% among dilated, ischaemic, and Chagas cardiomyopathy patient pools who underwent CRT. 34 The biological basis for these differences in outcome remains poorly understood and potentially driven by repetitive cardiac insults from re‐infections, cumulative effects of autonomic nervous system derangements and microvascular disturbances, as well as an increased frequency of ventricular arrhythmias, conduction abnormalities, right ventricular dysfunction, and thromboembolic events. In addition, patients with CCC face significant socio‐economic barriers to care that limit early diagnosis and access to medical treatment and specialized cardiac interventions.…”

Section: Discussionmentioning

confidence: 99%

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Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta‐analysis

Chadalawada

Rassi²,

Samara

et al. 2021

ESC Heart Failure

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Aims This study aimed to estimate the annual mortality risk and its determinants in chronic Chagas cardiomyopathy. Methods and results We conducted a systematic search in MEDLINE, Web of Science Core Collection, Embase, Cochrane Library, and LILACS. Longitudinal studies published between 1 January 1946 and 24 October 2018 were included. A random‐effects meta‐analysis using the death rate over the mean follow‐up period in years was used to obtain pooled estimated annual mortality rates. Main outcomes were defined as all‐cause mortality, including cardiovascular, non‐cardiovascular, heart failure, stroke, and sudden cardiac deaths. A total of 5005 studies were screened for eligibility. A total of 52 longitudinal studies for chronic Chagas cardiomyopathy including 9569 patients and 2250 deaths were selected. The meta‐analysis revealed an annual all‐cause mortality rate of 7.9% [95% confidence interval (CI): 6.3–10.1; I2 = 97.74%; T2 = 0.70] among patients with chronic Chagas cardiomyopathy. The pooled estimated annual cardiovascular death rate was 6.3% (95% CI: 4.9–8.0; I2 = 96.32%; T2 = 0.52). The annual mortality rates for heart failure, sudden death, and stroke were 3.5%, 2.6%, and 0.4%, respectively. Meta‐regression showed that low left ventricular ejection fraction (coefficient = −0.04; 95% CI: −0.07, −0.02; P = 0.001) was associated with an increased mortality risk. Subgroup analysis based on American Heart Association (AHA) classification revealed pooled estimate rates of 4.8%, 8.7%, 13.9%, and 22.4% (P < 0.001) for B1/B2, B2/C, C, and C/D stages of cardiomyopathy, respectively. Conclusions The annual mortality risk in chronic Chagas cardiomyopathy is substantial and primarily attributable to cardiovascular causes. This risk significantly increases in patients with low left ventricular ejection fraction and those classified as AHA stages C and C/D.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta‐analysis

Chadalawada

Rassi²,

Samara

et al. 2021

ESC Heart Failure

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“…However, there is little information regarding the benefit of CRT in ChCM. Although dyssynchrony may be present, most of the patients do not have LBBB, and there is little information regarding the benefit of CRT in ChCM [37,38]. However, there are some patients that receive a CRT when a replacement pacemaker is needed, or when a pacemaker is needed in the presence of systolic dysfunction, in order to avoid further clinical worsening resulting from the dyssynchrony induced by artificial cardiac stimulation, or less frequently, when a patient has LBBB a low LVEF.…”

Section: Left Ventricle In Chcmmentioning

confidence: 99%

WHF Recommendations for the Use of Echocardiography in Chagas Disease

et al. 2023

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Chagas disease (ChD) represents a significant health burden in endemic regions of Latin America and is increasingly being recognized as a global health issue. The cardiac involvement in ChD, known as Chagas cardiomyopathy (ChCM), is the most severe manifestation and a leading cause of heart failure and mortality in affected individuals. Echocardiography, a non-invasive imaging modality, plays a crucial role in the diagnosis, monitoring, and risk stratification of ChCM. This consensus recommendation aims to provide guidance on the appropriate use of echocardiography in ChD. An international panel of experts, including cardiologists, infectious disease specialists, and echocardiography specialists, convened to review the available evidence and provide practical recommendations based on their collective expertise.The consensus addresses key aspects related to echocardiography in ChD, including its role in the initial evaluation, serial monitoring, and risk assessment of patients. It emphasizes the importance of standardized echocardiographic protocols, including the assessment of left ventricular function, chamber dimensions, wall motion abnormalities, valvular involvement, and the presence of ventricular aneurysm. Additionally, the consensus discusses the utility of advanced echocardiographic techniques, such as strain imaging and 3D echocardiography, in assessing myocardial mechanics and ventricular remodeling.

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“…O alto grau de fibrose miocárdica, sobretudo em parede lateral de ventrículo esquerdo (VE) ou outras regiões alvo para posicionamento do eletrodo, pode ser um dos fatores que justifiquem a resposta pouco animadora a TRC. 4 …”

Section: Introductionunclassified

Ressincronização com Estimulação em Área de Ramo Esquerdo em Paciente Chagásico e Dependente da Estimulação Cardíaca Artificial: Relato de Caso

Galvão,

Pucci,

Vieira

et al. 2023

Arquivos Brasileiros De Cardiologia

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A cohort study of cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy

Abstract: This study showed that CCC patients submitted to CRT have worse prognosis compared to patients with DCM and ICM who undergo CRT. Studies comparing CCC patients with and without CRT are warranted.

Cited by 17 publications

References 16 publications

Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta‐analysis

Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta‐analysis

WHF Recommendations for the Use of Echocardiography in Chagas Disease

Ressincronização com Estimulação em Área de Ramo Esquerdo em Paciente Chagásico e Dependente da Estimulação Cardíaca Artificial: Relato de Caso

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