恰加斯病性心力衰竭与其他非缺血性和缺血性心肌病的当代特征及预后比较。
Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy.
作者信息
Shen Li, Ramires Felix, Martinez Felipe, Bodanese Luiz Carlos, Echeverría Luis Eduardo, Gómez Efraín A, Abraham William T, Dickstein Kenneth, Køber Lars, Packer Milton, Rouleau Jean L, Solomon Scott D, Swedberg Karl, Zile Michael R, Jhund Pardeep S, Gimpelewicz Claudio R, McMurray John J V
机构信息
From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (F.R.); Instituto DAMIC/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundación Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota, Colombia (E.A.G.); Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.); Stavanger University Hospital, University of Bergen, Norway (K.D.); Rigshospitalet Copenhagen University Hospital, Denmark (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA (S.D.S.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.); Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.); and Novartis Pharma, Basel, Switzerland (C.R.G.).
出版信息
Circ Heart Fail. 2017 Nov;10(11). doi: 10.1161/CIRCHEARTFAILURE.117.004361.
BACKGROUND
Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies.
METHODS AND RESULTS
This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; =0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; =0.002). The rates of all-cause mortality were also higher.
CONCLUSIONS
Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies.
CLINICAL TRIAL REGISTRATION
PARADIGM-HF: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00853658.
背景
恰加斯病是拉丁美洲心肌病的一个重要病因。我们旨在比较在现代心力衰竭治疗时代，由恰加斯病导致射血分数降低的心力衰竭（HF）患者与其他病因导致的HF患者的临床特征和预后。
方法与结果
本研究纳入了2552名拉丁美洲患者，这些患者被随机分配至PARADIGM-HF（血管紧张素受体脑啡肽酶抑制剂与血管紧张素转换酶抑制剂前瞻性比较以确定对心力衰竭全球死亡率和发病率的影响）和ATMOSPHERE（阿利吉仑试验以最小化心力衰竭患者结局）试验中。研究者报告的病因被分类为恰加斯病性、其他非缺血性或缺血性心肌病。感兴趣的结局包括心血管死亡或HF住院的复合结局及其组成部分以及任何原因导致的死亡。进行未调整和调整后的Cox比例风险模型以比较不同发病机制的结局。有195例射血分数降低的恰加斯病性HF患者、1300例其他非缺血性心肌病患者和1057例缺血性心肌病患者。与其他病因相比，恰加斯病患者女性更多、年龄更小，高血压、糖尿病和肾功能损害的患病率更低（但中风和起搏器植入的患病率更高），且健康相关生活质量更差。恰加斯病性、其他非缺血性和缺血性患者的复合结局发生率分别为每100人年17.2、12.5和11.4次——恰加斯病性与其他非缺血性相比的调整后风险比：1.49（95%置信区间，1.15 - 1.94；P = 0.003），恰加斯病性与缺血性相比：1.55（1.18 - 2.04；P = 0.002）。全因死亡率也更高。
结论
尽管年龄较轻、合并症较少且全面使用了传统HF治疗，但与其他病因相比，射血分数降低的恰加斯病性HF患者的生活质量仍然较差，住院率和死亡率更高。
临床试验注册
PARADIGM-HF：网址：http://www.clinicaltrials.gov。唯一标识符：NCT01035255；ATMOSPHERE：网址：http://www.clinicaltrials.gov。唯一标识符：NCT00853658。
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