Plasma norepinephrine, myocardial damage and left ventricular systolic function in Chagas' heart disease

Dávila, Diego F.; Bellabarba, Gabriela Arata de; Hernández, Luís E.; Calmon, Gustavo; Torres, Argenis; Donis, José H.; Barboza, Juan S.; Lemorvan, Ceciclia; Gonzalez, Jose G.

doi:10.1016/0167-5273(95)02459-a

Cited by 24 publications

(21 citation statements)

References 41 publications

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“…However, there are also similarities between Chagas cardiomyopathy pathophysiology and the mechanisms described in heart failure syndrome in general. Specifically, authors have reported that intracardiac sympathetic overactivity seems to occur in patients with Chagas disease and chronic heart failure, 26 and that catecholamines levels are increased in patients with Chagas disease and correlated with disease severity, 27 suggesting that the sympathetic activity play a significant role in the disease progression. 11 In resonance with this rationale, our results do support the use of ␤-blockers therapy in patients with Chagas cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

Issa

Amaral

Cruz

et al. 2010

Circ: Heart Failure

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Background-Peculiar aspects of Chagas cardiomyopathy raise concerns about efficacy and safety of sympathetic blockade. We studied the influence of ␤-blockers in patients with Chagas cardiomyopathy. Methods and Results-We examined REMADHE trial and grouped patients according to etiology (Chagas versus non-Chagas) and ␤-blocker therapy. Primary end point was all-cause mortality or heart transplantation. Altogether 456 patients were studied; 27 (5.9%) were submitted to heart transplantation and 202 (44.3%) died. compared with those who received ␤-blockers. Survival was lower in patients with Chagas heart disease as compared with other etiologies. When only patients under ␤-blockers were considered, the survival of patients with Chagas disease was similar to that of other etiologies. The survival of patients with ␤-blockers was higher than that of patients without ␤-blockers. In Cox regression model, left ventricle end-diastolic diameter (hazard ratio, 1.78; CI, 1.15 to 2.76; Pϭ0.009) and ␤-blockers (hazard ratio, 0.37; CI, 0.14 to 0.97; Pϭ0.044) were associated with better survival. Conclusions-Our study suggests that ␤-blockers may have beneficial effects on survival of patients with heart failure and Chagas heart disease and warrants further investigation in a prospective, randomized trial. Clinical Trial Registration-clinicaltrials.gov. Identifier: NCT00505050.(Circ Heart Fail. 2010;3:82-88.)

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Section: Discussionmentioning

confidence: 99%

β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

Issa

Amaral

Cruz

et al. 2010

Circ: Heart Failure

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“…However, no study has addressed this question in Chagas disease patients, and guidelines do not recommend such drugs to patients with this condition. Nonetheless, inasmuch as the activation of the Renin-Angiotensin-Aldosterone System appears to be similar in Chagas and non-Chagas disease patients with CHF, [35][36][37] it would be reasonable to suggest such drugs for the treatment of asymptomatic left ventricular dysfunction in patients with CHF secondary to Chagas cardiomyopathy in the stage B.…”

Section: Stage Bmentioning

confidence: 99%

The treatment of chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era

Bestetti¹,

Daniel²

2016

ICFJ

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<p>Chronic Heart Failure (CHF) affects about half patients with Chagas cardiomyopathy. Outcome of CHF secondary to Chagas cardiomyopathy is relentless with an annual mortality approaching 20%, which is higher than that observed in non-Chagas disease heart failure. The pathophysiology of Chagas disease is similar to that found in non-Chagas disease heart failure with a marked activation of the neurohormonal system. No randomized trial has been conducted in patients with Chagas cardiomyopathy with CHF to assess the effect of a drug on mortality of such patients. Therefore, the treatment of CHF secondary to Chagas cardiomyopathy relies on drugs prescribed to patients with non-Chagas disease heart failure<strong>. </strong>Patients with Chagas disease heart failure have been classified into stages A to D according to the American College of Cardiology/American Heart Association. Little can be done to patients in the stage A of CHF, except for treatment of comorbidities. In patients in the stage B of CHF, aldosterone receptor antagonist, angiotensin converting enzyme inhibitors (ACEI), and Betablockers (BB) can be indicated. In patients in the stage C of CHF, the same drugs are of value. In addition, diuretics, digoxin, angiotensin receptor blockers to patients intolerant to ACEI have also been used. Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator may have indications similar to that of non-Chagas disease patients. In stage D of CHF, heart transplantation is a valid option for patients with this condition. </p>

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“…In humans with Chagas disease the sympathetic innervation of the heart, evaluated using scintigraphy with radio-isotopes, was found to be diminished as reported by Simões and associates 38 . An indirect study of peripheral sympathetic innervation using catecholamine concentrations or blood pressure variations indicates alterations in the sympathetic function 39 . Data from an earlier study conducted by our group with a similar population of Chagas patients revealed an increased peripheral chemorefl ex response 9 , indicating alterations in the peripheral sympathetic response of these patients.…”

Section: Discussionmentioning

confidence: 99%

Disfunção endotelial venosa em pacientes com doença de Chagas sem insuficiência cardíaca

Plentz¹,

Irigoyen²,

Müller³

et al. 2006

Arq. Bras. Cardiol.

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Original Article M a i l i n g A d d r e s s : R o d r i g o D el l a M e á P l e n t z • R u a J o ã o M a n o e l , 1 3 5 2 -9 8 1 0 -5 1 7 0 -C r u z A l t a , R S -B r a z i l E-mail: roplentz@yahoo.com. OBJECTIVETo analyze the venous endothelial function in Chagas' disease patients without heart failure. METHODSThe Chagas' disease Group (G1) was composed by 14 women and 2 men aged 46 ± 2,7 and the Control Group (G0) by 7 women and 1 man matched by age, weight and height. Dorsal Hand Vein Compliance Technique was used to evaluate the venous endothelial function. Crescent doses of phenylephrine were infused to get a 70% preconstriction of the vein; after that, acetylcholine and sodium nitroprusside were respectively administrated to analyze the endothelium-dependent and -independent venodilation. RESULTSNo significant systemic hemodynamic changes were observed in both groups during the experiment. The necessary phenylephrine dose to reach 70% preconstriction of the vein was signifi cantly higher in the G1 (1116 ± 668,2 ng/ml) compared to G0 (103 ± 28 ng/ml) p = 0,05. The endothelium-dependent venous dilation was signifi cantly lower in G1 (65,5 ± 8%) compared to G0 (137 ± 20 %) p = 0,009. No difference was observed in the endothelium-independent venous dilatation between groups.

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Plasma norepinephrine, myocardial damage and left ventricular systolic function in Chagas' heart disease

Cited by 24 publications

References 41 publications

β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

The treatment of chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era

Disfunção endotelial venosa em pacientes com doença de Chagas sem insuficiência cardíaca

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