Chagas cardiomyopathy and captopril

Abstract

Chagas disease is a leading cause of heart failure in Latin America. Sudden death occurs in approximately 40% of patients with heart failure due to Chagas disease. We report a single blind, cross-over trial of prolonged treatment with captopril and placebo in 18 Chagas disease patients with class IV NYHA heart failure. Ventricular dimensions, neurohormones, electrolytes and ventricular arrhythmias were analysed in 11 men and seven women receiving stable doses of digoxin and frusemide who were randomly divided into two intervention groups. Group I patients were given increasing doses of captopril up to 150 mg.day-1 maintained for 6 weeks, group II received the placebo. A 24 h Holter, 2-D echocardiogram, urinary catecholamines, plasma renin and electrolyte determinations were performed at the end of each phase. After a 2-week washout period, the two groups crossed over and another period of 6 weeks was observed. Ventricular arrhythmias were analysed by either Mann-Whitney or the Wilcoxon test. Remaining data were assessed by the Student t-test. A significant reduction in heart rate and urinary catecholamine levels, and enhanced plasma levels of renin, together with a reduction in ventricular couplets was found in the captopril-treated group. We conclude that captopril has a beneficial effect on neurohormones with a subsequently reduced heart rate and diminished incidence of ventricular arrhythmias in patients with Chagas disease. This effect might result in a reduction of mortality caused by the disease, suggesting the need for further investigations.

2 nd Brazilian Consensus on Chagas Disease, 2015

“…When it is imperative to use high doses of loop diuretics, such as furosemide, one should be aware of the higher likelihood of hypokalemia and/or hyponatremia, which, in turn, can exacerbate or trigger serious arrhythmias (248) . In CCC with heart failure or asymptomatic systolic dysfunction (ejection fraction <45%), the chronic administration of ACE inhibitors is indicated to reduce the morbidity, mortality or ARB, when patients are intolerant to ACE inhibitors (256) . With the same purpose, the use of spironolactone is recommended in cases with heart failure, in NYHA functional classes II-IV (248) .…”

Chagas' heart disease

“…Preliminary studies involving therapy with ACEinhibitors, enrolling small numbers of patients, have shown promising results in heart failure complicating Chagas' disease 172,173 , in regard to symptomatic control. Although no long-term prospectively controlled study has been reported assessing the impact on survival of chagasic patients treated with ACE-inhibitors or any other pharmacological interventions, there is no reason to expect that their beneficial effect would be any different from that observed in heart failure due to other etiologies.…”

Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

“…These individuals are candidates for preventive treatment with angiotensin-converting enzyme inhibitors, which can delay the appearance of symptoms and reduce mortality in the presence of left ventricular dysfunction 17 . Although the beneficial effects of these drugs on the survival of patients with Chagas' heart disease have not been formally tested, their beneficial clinical and hemodynamic effects on patients with Chagas' heart disease are evident 18,19 . In addition, these drugs are indicated in all patients with left ventricular dysfunction, symptomatic or not, independent of its etiology 20 .…”