Pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy

Martí‐Carvajal, Arturo J; Kwong, Joey S.W.

doi:10.1002/14651858.cd009077.pub3

Cited by 17 publications

(7 citation statements)

References 105 publications

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“…However, the recommended full doses of these drugs are often not reached, as patients with CHD have a high prevalence of atrioventricular block and autonomic nervous system disorders. Carvedilol is the most frequently used beta-blocker in CHD, although the quality of evidence is low and based on a meta-analysis that included 69 participants and found a lower all-cause mortality in the carvedilol group than in the placebo group[ 96 ].…”

Section: Heart Failurementioning

confidence: 99%

Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care

Saraiva¹,

Mediano²,

Mendes³

et al. 2021

WJC

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Chagas heart disease (CHD) affects approximately 30% of patients chronically infected with the protozoa Trypanosoma cruzi . CHD is classified into four stages of increasing severity according to electrocardiographic, echocardiographic, and clinical criteria. CHD presents with a myriad of clinical manifestations, but its main complications are sudden cardiac death, heart failure, and stroke. Importantly, CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies, and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other etiologies. Among patients with CHD, approximately 90% of deaths can be attributed to complications of Chagas disease. Sudden cardiac death is the most common cause of death (55%–60%), followed by heart failure (25%–30%) and stroke (10%–15%). The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents with. Therefore, the management of CHD is challenging, and in this review, we present the most updated available data to help clinicians and cardiologists in the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.

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Section: Heart Failurementioning

confidence: 99%

Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care

Saraiva¹,

Mediano²,

Mendes³

et al. 2021

WJC

View full text Add to dashboard Cite

show abstract

“…Although evidence is scant regarding the use of dual angiotensin receptor and neprilysin inhibitors (ARNI) and sodium-glucose transporter 2 inhibitors (SGLT-2), clinical trials are currently ongoing given the fact that approximately 7.6% of patients enrolled in the PARADIGM-HF, and the ATMOSPHERE trials, were diagnosed with Ch-CMP. Both medications are promising options for the treatment of Ch-CMP, an otherwise often refractory and highly morbid cause of heart failure [167][168][169][170]. Likewise, SCD prevention is based in the insertion of an implantable cardiac defibrillator and amiodarone therapy [171][172][173].…”

Section: Clinical Manifestations Diagnosis and Treatmentmentioning

confidence: 99%

Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review

et al. 2021

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Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi’s infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite’s life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.

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“…Three trials evaluating carvedilol in ChCM were identified, with a total of 108 participants. [84] A lower proportion of all-cause mortality was found in the carvedilol groups compared with the placebo groups (RR 0.69; 95% CI [0.12–3.88]), with no difference in hospital readmissions. However, the authors found that the available evidence was low quality and there were no conclusive data to support or reject the use of carvedilol.…”

Section: Drug Heart Failure Management: Similar or Different?mentioning

confidence: 99%

Chagas Disease and Heart Failure: An Expanding Issue Worldwide

Martínez

Perna

Perrone³

et al. 2019

Eur Cardiol

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Chagas disease, originally a South American endemic health problem, is expanding worldwide because of people migration. Its main impact is on the cardiovascular system, producing myocardial damage that frequently results in heart failure. Pathogenic pathways are mainly related to inmunoinflamatory reactions in the myocardium and, less frequently, in the gastrointestinal tract. The heart usually shows fibrosis, producing dilatation and damage of the electrogenic cardiac system. These changes result in cardiomyopathy with heart failure and frequent cardiac arrhythmias and heart blocks. Diagnosis of the disease must include a lab test to detect the parasite or its immune reactions and the usual techniques to evaluate cardiac function. Therapeutic management of Chagas heart failure does not differ significantly from the most common treatment for dilated cardiomyopathy, with special focus on arrhythmias and several degrees of heart block. Heart transplantation is reserved for end-stage cases. Major international scientific organisations are delivering recommendations for prevention and early diagnosis. This article provides an analysis of epidemiology, prevention, treatment and the relationship between Chagas disease and heart failure.

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Pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy

Cited by 17 publications

References 105 publications

Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care

Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care

Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review

Chagas Disease and Heart Failure: An Expanding Issue Worldwide

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