Chagas disease is associated with a poor outcome at 1-year follow-up after cardiac resynchronization therapy

Abstract

SUMMARY BACKGROUND: Cardiac resynchronization therapy (CRT) is a therapeutic modality for patients with heart failure (HF). The effectiveness of this treatment for event reduction is based on clinical trials where the population of patients with Chagas' disease (DC) is underrepresented. OBJECTIVE: To evaluate the prognosis after CRT of a population in which CD is an endemic cause of HF. METHODS: A retrospective cohort conducted between January 2015 and December 2016 that included patients with HF and left ventricular ejection fraction (LVEF) of less than 35% and undergoing CRT. Clinical and demographic data were collected to search for predictors for the combined outcome of death or hospitalization for HF at one year after CRT implantation. RESULTS: Fifty-four patients were evaluated, and 13 (24.1%) presented CD as the etiology of HF. The mean LVEF was 26.2± 6.1%, and 36 (66.7%) patients presented functional class III or IV HF. After the mean follow-up of 15 (±6,9) months, 17 (32.1%) patients presented the combined outcome. In the univariate analysis, CD was associated with the combined event when compared to other etiologies of HF, 8 (47%) vs. 9 (13,5%), RR: 3,91 CI: 1,46–10,45, p=0,007, as well as lower values of LVEF. In the multivariate analysis, CD and LVEF remained independent risk factors for the combined outcome. CONCLUSION: In a population of HF patients undergoing CRT, CD was independently associated with mortality and hospitalization for HF.

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

“… 768 , 769 Annual all-cause mortality in those two studies ranged from 9.0% to 9.2%. In other three studies, 770 - 772 the survival of patients with CCCD was significantly lower and the percentage of nonresponders to CRT was significantly higher as compared to that of patients with other cardiomyopathies. In patients undergoing CRT, the presence of CCCD increased the risk of death by approximately two to four times.…”

“…Em pacientes submetidos à TRC, a presença de CCDC aumentou o risco de óbito em cerca de 2 a 4 vezes. 770 , 772 …”

“…So far, only five single-center, observational studies 768 - 772 have assessed the clinical course of patients with CCCD undergoing CRT, and three of them 770 - 772 have compared the effect of that therapy in CCCD with that in other cardiopathies ( Table 11.9 ). A statistically significant reduction in LVDD and a significant improvement in NYHA functional class and LVEF were observed with CRT in two studies including only patients with CCCD.…”

Heart failure patients with prior right ventricular pacing upgraded to resynchronization therapy had a worse prognosis compared to de novo cardiac resynchronization therapy at 1-year follow-up. Results from a Chagas disease cohort

“…Simirlaly, Passos, et al also demonstrated a worse prognosis in combined events in patients with Chagas cardiomyopathy after CRT. 7,8 It is important to emphasize that, since intrinsic LBBB in Chagas heart disease is uncommon, and it is considered an arrhythmogenic cardiomyopathy characterized by a wide variety of abnormalities of the conduction, it is expected a higher incidence of upgraded-CRT implantation in this patients. In fact, in the cohort presented by Martinelli et al, there was a 73.9% incidence of induced-LBBB in Chagas' disease patients undergoing CRT.…”

“…It is well established that CD patients had a worse prognosis compared to other HF etiologies, and recent studies suggests that these patients also have a higher short-term mortality rate after CRT. 7,8 As the need for a pacemaker implantation is common in the course of CD cardiomyopathy, and since LBBB is relatively rare in this patients, an expected higher incidence of upgrade-CRT implantation in this population might play a role in worsening the outcomes. Thus, the aim of this study is to compare the short-term mortality between upgrade and de Novo-CRT implantation in a heart failure population where Chagas disease is endemic.…”