Heart Institute (InCor), University of São Paulo Medical School, Av. Enéas de Carvalho Aguiar, São Paulo, SP, Brazil.
Europace. 2018 Nov 1;20(11):1813-1818. doi: 10.1093/europace/eux375.
Cardiac resynchronization therapy (CRT) is an established procedure for patients with heart failure. However, trials evaluating its efficacy did not include patients with chronic Chagas cardiomyopathy (CCC). We aimed to assess the role of CRT in a cohort of patients with CCC.
This retrospective study compared the outcomes of CCC patients who underwent CRT with those of dilated (DCM) and ischaemic cardiomyopathies (ICM). The primary endpoint was all-cause mortality and the secondary endpoints were the rate of non-advanced New York Heart Association (NYHA) class 12 months after CRT and echocardiographic changes evaluated at least 6 months after CRT. There were 115 patients in the CCC group, 177 with DCM, and 134 with ICM. The annual mortality rates were 25.4%, 10.4%, and 11.3%, respectively (P < 0.001). Multivariate analysis adjusted for potential confounders showed that the CCC group had a two-fold [hazard ratio 2.34 (1.47-3.71), P < 0.001] higher risk of death compared to the DCM group. The rate of non-advanced NYHA class 12 months after CRT was significantly higher in non-CCC groups than in the CCC group (DCM 74.0% vs. ICM 73.9% vs. 56.5%, P < 0.001). Chronic Chagas cardiomyopathy and ICM patients had no improvement in the echocardiographic evaluation, but patients in the DCM group had an increase in left ventricular ejection fraction and a decrease in left ventricular end-diastolic diameter.
This study showed that CCC patients submitted to CRT have worse prognosis compared to patients with DCM and ICM who undergo CRT. Studies comparing CCC patients with and without CRT are warranted.
心脏再同步治疗（CRT）是心力衰竭患者的一种既定治疗方法。然而，评估其疗效的试验并未纳入慢性恰加斯心肌病（CCC）患者。我们旨在评估 CRT 在一组 CCC 患者中的作用。
这项回顾性研究比较了接受 CRT 的 CCC 患者与扩张型心肌病（DCM）和缺血性心肌病（ICM）患者的结局。主要终点是全因死亡率，次要终点是 CRT 后 12 个月的非高级纽约心脏协会（NYHA）心功能分级 1 级的发生率和 CRT 后至少 6 个月时的超声心动图变化。CCC 组有 115 例患者，DCM 组有 177 例，ICM 组有 134 例。每年死亡率分别为 25.4%、10.4%和 11.3%（P<0.001）。多变量分析调整了潜在混杂因素后显示，与 DCM 组相比，CCC 组的死亡风险增加了两倍[危险比 2.34（1.47-3.71），P<0.001]。非 CCC 组 CRT 后 12 个月非高级 NYHA 心功能分级的发生率明显高于 CCC 组（DCM 74.0%比 ICM 73.9%比 56.5%，P<0.001）。CCC 和 ICM 患者的超声心动图评估没有改善，但 DCM 组患者的左心室射血分数增加，左心室舒张末期直径减小。
本研究表明，与接受 CRT 的 DCM 和 ICM 患者相比，接受 CRT 的 CCC 患者预后更差。有必要对 CCC 患者进行 CRT 与非 CRT 治疗的比较研究。
