Different prognostic impact of the tissue Doppler-derived E/e′ ratio on mortality in Chagas cardiomyopathy patients with heart failure

Nunes, Maurício Buzelin; Colosimo, Enrico A.; Reis, Rodrigo Citton Padilha dos; Barbosa, Márcia M.; Silva, José Luiz Padilha da; Barbosa, Felipe Batista Lima; Botoni, Fernando Antônio; Ribeiro, Antônio Luiz Pinho; Rocha, Manoel Otávio da Costa

doi:10.1016/j.healun.2012.01.865

Cited by 33 publications

(34 citation statements)

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“…Therefore, one of the most important goals of studying physiopathological mechanisms in Chagas disease is the identification of potential risk factors for the occurrence of major clinical events (sudden death, heart failure, malignant arrhythmias, and stroke) or disease progression among patients still in the indeterminate form or in initial stages of the cardiac form (5,6). Chagas heart disease is characterized by an intense and progressive fibrotic process (4), and the study of biomarkers involved in the establishment and development of fibrosis is essential to identify such potential risk factors (35).…”

Section: Discussionmentioning

confidence: 99%

“…However, about 20 to 30% of the patients develop the cardiac form of the disease, which can be complicated by cardiac arrhythmias, heart failure, stroke, and sudden death (2,3). Chagas heart disease is characterized by intense myocarditis of an inflammatory nature with a progressive fibrotic process affecting the myocardium of both ventricles, which leads to myocardial remodeling, interstitial fibrosis, and changes in the extracellular matrix (ECM) (4)(5)(6). The ECM remodeling is regulated by proteolytic enzymes, such as matrix metalloproteinases (MMPs) (7).…”

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confidence: 99%

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Matrix Metalloproteinases 2 and 9 Are Differentially Expressed in Patients with Indeterminate and Cardiac Clinical Forms of Chagas Disease

et al. 2013

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confidence: 99%

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confidence: 99%

Matrix Metalloproteinases 2 and 9 Are Differentially Expressed in Patients with Indeterminate and Cardiac Clinical Forms of Chagas Disease

et al. 2013

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“…Another important point to be considered is the absolute hegemony of studies carried out in Brazil (77% of those included in this review) 4,6-9,11,12,14-19,21-26,28-36,38,40-43 . Among the five studies performed in other countries, three were carried out in Latin America 13,20,27 and two in Europe 37,39 .…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the use of comparison groups, it was observed that in 18 articles (58%) the authors used the design of comparisons between groups 8,13-18,21,24,26,27,31,35,37,33,40-41,43 . It is also interesting to note the predominance of adult patients in the selected studies, with only one study including adolescent chagasic patients 23 .…”

Section: Resultsmentioning

confidence: 99%

“…As for the addressed topics, 10 articles considered prognostic factors of mortality and risk of disease progression using echocardiography 13,19,22,23,26,28,30,32,35,36 , five studies assessed left ventricular ejection fraction (LVEF) 20,25,29,34,39 , alone or together with prognostic factors, seven articles assessed systolic and diastolic ventricular function with tissue Doppler 15-17,27,33,36,40 , five assessed concentrations of brain natriuretic peptide (BNP) 21,24,29,31,37 , one study assessed the prognostic value of troponin concentrations 18 , one study evaluated ventricular dyssynchrony 38 , two studies assessed cardiac dysautonomia 14,41 , two studies used two-dimensional echocardiography to assess ventricular deformation (strain, strain rate and twisting) 33,42 and one study addressed the proinflammatory and prothrombotic factors in Chagas disease 43 .…”

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confidence: 99%

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Clinical and Echocardiographic Predictors of Mortality in Chagasic Cardiomyopathy - Systematic Review

Júnior¹,

Filho²

2014

Arquivos Brasileiros De Cardiologia

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Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed), LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease.

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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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Different prognostic impact of the tissue Doppler-derived E/e′ ratio on mortality in Chagas cardiomyopathy patients with heart failure

Cited by 33 publications

References 33 publications

Matrix Metalloproteinases 2 and 9 Are Differentially Expressed in Patients with Indeterminate and Cardiac Clinical Forms of Chagas Disease

Matrix Metalloproteinases 2 and 9 Are Differentially Expressed in Patients with Indeterminate and Cardiac Clinical Forms of Chagas Disease

Clinical and Echocardiographic Predictors of Mortality in Chagasic Cardiomyopathy - Systematic Review

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

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