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Clinical manifestations and outcome of acute heart failure in Chagas cardiomyopathy patients in comparison do other etiologies: results of the I Brazilian Heart Failure Registry

Session Acute heart failure: how to improve survival

Speaker Associate Professor Marcus Vinicius Simoes

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Rapid Fire Abstracts

Authors : MV Simoes (Ribeirão Preto,BR), CH Miranda (Ribeirão Preto,BR), DC Albuquerque (Rio de Janeiro,BR), LC Danzmann (Porto Alegre,BR), S Rassi (Goiania,BR), HP Guimaraes (Sao Paulo,BR), MF Canesin (Londrina,BR), LEP Rohde (Porto Alegre,BR)

Authors:
MV Simoes1 , CH Miranda1 , DC Albuquerque2 , LC Danzmann3 , S Rassi4 , HP Guimaraes5 , MF Canesin6 , LEP Rohde7 , 1Medical School of Ribeirão Preto - University of São Paulo, Brazil - Ribeirão Preto - Brazil , 2State University of Rio de Janeiro (UFRJ), Cardiology - Rio de Janeiro - Brazil , 3Lutheran University of Brazil, Cardiology - Porto Alegre - Brazil , 4Federal University of Goias, Cardiology - Goiania - Brazil , 5Hospital for the Heart (Hcor), Cardiology - Sao Paulo - Brazil , 6University Hospital, State University of Londrina, Cardiology - Londrina - Brazil , 7Federal University of Rio Grande do Sul, Cardiology - Porto Alegre - Brazil ,

On behalf: BREATHE - Brazilian Heart Failure Registry

Citation:

Background: Chagas cardiomyopathy (CC) is a prevalent cause of heart failure in Latin America countries and has recently been spread to Europe owing globalization and migratory waves from endemic regions. Studies describing clinical manifestations and outcomes of heart failure associated to CC are scarce and restricted to single center reports.

Purpose: Report the results of the I Brazilian Heart Failure Registry (BREATHE) addressing the clinical characteristics and outcomes of patients with acute heart failures (AHF) due to CC in comparison to other etiologies.

Methods:  BREATHE was a multicenter observational nationwide prospective registry, conducted in 51 Brazilian hospitals, including private and public institutions, from different Brazilian regions. BREATHE included 1,253 patients, >18 years-old patients hospitalized with primary diagnosis of AHF. We proceeded the comparative analysis between patient group with CC etiology (n=136, 10.9% of the sample) and patients with other etiology (n=1,117, 89.1% of the sample), concerning demographic, physical examination changes at admission, non-invasive clinical/hemodynamic profile, LVEF on Echocardiogram, use of intravenous inotropic drugs, and death rate during hospital stay and 3, 6 and 12 months after discharge. The categorical variables were compared by using Fisher Exact test and the continuous variables were compared by using Mann-Whitney non-parametric test.

Results: CC patients, in comparison to other etiologies, were younger (62.5±15.2 vs 69.9±16.1 y.o., p<0.01), presented lower systolic blood pressure (104.2±24.9 vs 127.0±31.4 mmHg, p<0.001), lower heart rate (76.8±23.3 vs 89.1±22.3 bpm, p<0.001), lower rate of jugular vein distension (63.2% vs 44.8%, p<0.001) and hepatomegaly (59.6% vs 34.4%, p<0.001), lower rate of pulmonary crackles (64.0% vs 73.7%, p=0.022), higher rate of "cold and wet" clinical hemodynamic profile (36.0 vs 15.7%, p<0.001), larger diastolic left ventricular diameters (68 [57.2 - 74.0] mm, p=0.017), lower left ventricular ejection fraction (29.5 [22.2 - 35.5]% vs 37 [26.0 - 49.8]%, p<0.001), higher rates of intravenous inotropic drugs use (31.5% vs 12.4%, p<0.001). The CC patients in comparison to non-CC patients presented higher cumulative death rate during hospital stay (20.6% vs 11.7%, p=0.009), and after discharge at 3-months (34.3% vs 22.1%, p=0.002, at 6-months (41.0% vs 27.7%, p=0.002, and at 12-months (53.4% vs 37.8%, p=0.001).

Conclusions: Patients hospitalized with AHF with CC etiology, in comparison to other etiologies, present more prominent physical signs of systemic congestion, lower arterial blood pressure, more severe left ventricular systolic dysfunction and remodeling, more frequent low cardiac output manifestations and higher use of intravenous inotropic drugs. This higher risk profile was associated to a poorer outcome both in-hospital and after discharge.

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