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Pulmonary thromboembolism (PE) is a potential major complication in patients with chronic Chagas heart disease (CChD). The source of PE is the right-sided chambers instead of deep vein thrombosis. Little is known regarding risk factors, clinical picture, and the clinical course of patients with PE secondary to CChD. The aim of this review was to try to provide doctors with such data. We searched for papers related to PE in CChD patients in the PUBMED from 1955 to 2020. Twenty-six manuscripts were retrieved, of which 12 fulfilled entry criteria and were included in the study. Right-sided cardiac thrombosis or PE was confirmed on morphological or imaging studies. A total of 431 patients with PE were reported. Age varied from 30 to 85 years. About 332 patients were reported to have chronic heart failure (CHF), whereas 41 (9%) sudden cardiac death (SCD) at autopsy. Clinical manifestations reported were sudden onset dyspnea was found in 1 patient, haemoptysis in 2, worsening CHF in 2, and chest pain in 1. An X-ray chest was reported for 6 patients: abnormalities consistent with PE were found in 3. The resting electrocardiogram (ECG) was reported for 5 patients: it was abnormal in all. One study reported a mean left ventricular ejection fraction of 42.1 ± 18.7%. The prevalence of right-sided cardiac thrombosis varied from 66% to 85% patients. PE was the cause of death in 17% of patients. The clinical diagnosis of PE in patients with Chagas cardiomyopathy (ChCM) is very difficult in the absence of a prediction score that performs well. However, in the presence of haemoptysis or worsening heart failure (HF), abnormal ECG, or chest X-ray, the diagnosis of PE should be raised, and patients promptly referred to detailed Doppler Tissue Echocardiography and computed tomography angiography, and treated in a timely manner.

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BACKGROUND: The prevalence and the outcomes of patients with chronic Chagas heart disease with obstructive coronary artery disease (CCHD-CAD) and chronic heart failure (CHF) with precordial chest pain are unsettled. Accordingly, the aim of this study was to determine the prevalence and clinical course of patients with CHF secondary to CCHD-CAD. METHODS: Patients with positive serology for Chagas disease and systolic CHF were included; those with precordial chest pain and at least two risk factors for CAD underwent coronary arteriogram. RESULTS: In total 262 patients were included in the investigation; 234 (89%) had CHF secondary to CCHD alone, and 28 (11%) with CHF secondary to CCHD-CAD, as observed at coronary arteriogram. The survival probability of patients with CHF secondary to CCHD alone at 12, 24, 36, 48 and 72 mo was 79%, 64%, 54%, 44% and 33%, respectively, whereas survival probability for patients with CHF secondary to CCHD-CAD at 12, 24, 36, 48 and 72 mo was 96%, 80%, 71%, 66% and 57%, respectively (p=0.04). CONCLUSIONS: In patients with CCHD with CHF, the prevalence of CAD of 11% is not neglectable in those with precordial chest pain. The outcome for patients with precordial chest pain with CHF secondary to CCHD-CAD is better than that observed in patients with CHF secondary to CCHD alone.

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Chagas disease (CD) is a neglected protozoan infection caused by Trypanosoma cruzi, which affects about 7 million people worldwide. There are two available drugs in therapeutics, however, they lack effectiveness for the chronic stage-characterized mainly by cardiac (i.e., cardiomyopathy) and digestive manifestations (i.e., megaesophagus, megacolon). Due to the involvement of the immuno-inflammatory pathways in the disease's progress, compounds exhibiting antioxidant and anti-inflammatory activity seem to be effective for controlling some clinical manifestations, mainly in the chronic phase. Resveratrol (RVT) and curcumin (CUR) are natural compounds with potent antioxidant and anti-inflammatory properties and their cardioprotective effect have been proposed to have benefits to treat CD. Such effects could decrease or block the progression of the disease's severity. The purpose of this systematic review is to analyze the effectiveness of RVT and CUR in animal and clinical research for the treatment of CD. The study was performed according to PRISMA guidelines and it was registered on PROSPERO (CDR42021293495). The results did not find any clinical study, and the animal research was analyzed according to the SYRCLES risk of bias tools and ARRIVE 2.0 guidelines. We found 9 eligible reports in this study. We also discuss the potential RVT and CUR derivatives for the treatment of CD as well.

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INTRODUCTION: Considering the importance of ventricular arrhythmias in the prediction of sudden cardiac death in chronic Chagas heart disease, the aim of the present study was to associate late potentials observed in the signal-averaged electrocardiogram (SAECG) with either non-sustained ventricular tachycardia in the 24-hour Holter monitoring or reduced left ventricular ejection fraction in the 2-dimension echocardiogram. METHODS: This was a retrospective transversal study. The medical charts of 49 patients with chronic Chagas heart disease that underwent 24-hour Holter monitoring at our institution from September 2012 to December 2015 were reviewed. In the univariate analysis, variables associated with SAECG at a p value <0.05 were entered a multivariate stepwise logistic regression analysis through the model forward. A p value <0.05 was considered to have statistical significance. RESULTS: In the univariate analysis, right bundle branch block, left atrial diameter, left ventricular systolic diameter, and left ventricular ejection fraction were associated with late potential in the SAECG. In the multivariate analysis, however, right bundle branch block and left atrial diameter were retained as independent predictors of late potentials in the SAECG. CONCLUSIONS: Neither ventricular arrhythmias in the 24-Holter monitoring nor reduced left ventricular ejection fraction in the 2-D echocardiogram were associated with late potentials in the SAECG of patients with chronic Chagas heart disease.

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BACKGROUND: Few studies regarding chronic kidney disease (CKD) and anemia have been conducted in patients with Chagas cardiomyopathy (CC). We evaluated the risk prediction performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and anemia in CC patients. METHODS: From 2000 to 2010, a total of 232 patients were studied in a single-center retrospective study. CKD was defined as creatinine clearance <60 mL/min/1.73 m2 according to CKD-EPI equation. Anemia was defined as hemoglobin <12 g/dL (women) and <13 g/dL (men). Cox proportional hazards models were used to establish predictors for death. RESULTS: At baseline, 98 individuals (42.2%) had criteria for CKD and 41 (17.7%) for anemia. During follow-up, 136 patients (58.6%) died. Independently, CKD and anemia were not associated with all-cause mortality. However, when they coexisted, an additional risk was attributed for these patients. Cox proportional hazard models analysis identified systolic blood pressure (hazard ratio, 0.99; 95% confidence interval (CI), 0.98 to 1.00; P=0.015), implantable cardioverter-defibrillator (hazard ratio, 0.48; 95% CI, 0.27 to 0.85; P=0.012), left anterior fascicular block (hazard ratio, 1.52; 95% CI, 1.08 to 2.13; P=0.017), left ventricular end-diastolic diameter (hazard ratio, 1.04; 95% CI, 1.02 to 1.06; P < 0.001), and serum sodium (hazard ratio, 0.95; 95% CI, 0.92 to 0.99; P=0.020) as independent predictors for death. CONCLUSIONS: CKD and anemia are not independent predictors for long-term mortality in CC patients. However, the prognosis is poorer in individuals with both comorbidities.

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BACKGROUND: Clinical independent predictors of inducible sustained ventricular tachycardia (VT) during electrophysiologic study (EPS) are not known in patients with chronic Chagas' heart disease. The purpose of this investigation was to fill this gap. METHODS: The medical charts of 47 patients with a positive serology for Chagas' disease who had undergone EPS between September 2006 and July 2012 at our institution were reviewed. Reasons for the EPS were the presence of unexplained syncope, non-sustained ventricular tachycardia (NSVT) on either resting ECG or 24 h-Holter monitoring as well as a LVEF < 55% and > 35% at echocardiography. A stepwise logistic regression analysis was performed to identify noninvasive predictors of inducible sustained VT/ventricular fibrillation during EPS. RESULTS: On univariate analysis, syncopal episodes (p = 0.04), amiodarone therapy (p < 0.005), diastolic blood pressure (p = 0.03), creatinine serum levels (p < 0.001), potassium serum levels (p < 0.001), and lengthening of the QRS complex (p = 0.03) were associated with inducible sustained VT during EPS. In the multivariate model, amiodarone therapy (p = 0.03; hazard ratio = 10; Wald coefficient = 4.5; 95% confidence interval 1.2 to 85.2) was the only variable retained as independent predictor of inducible sustained VT during EPS. CONCLUSION: Amiodarone therapy was the only independent variable associated with sustained VT inducibility during EPS in patients with chronic Chagas' heart disease.

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Carlos Chagas, the discoverer of Chagas' disease was nominated to the Nobel Prize in 1921, but none did win the prize in that year. As a leader of a young scientist team, he discovered all aspects of the new disease from 1909 to 1920. It is still obscure why he did not win the Nobel Prize in 1921. Chagas was discarded by Gunnar Hedrèn on April 16, 1921. Hedrèn should have made a written report about the details of his evaluation to the Nobel Committee. However, such a document has not been found in the Nobel Committee Archives. No evidence of detractions made by Brazilian scientists on Chagas was found. Since Chagas nomination was consistent with the Nobel Committee requirements, as seen in the presentation letter by until now unknown Cypriano de Freitas, it become clear that Chagas did not win the Nobel Prize exclusively because the Nobel Committee did not perceive the importance of his discovery. Thus, it would be fair a posthumous Nobel Prize of 1921 to Carlos Chagas. A diploma of the Nobel Prize, as precedent with Dogmack in 1947, would recognize the merit of the scientist who made the most complete medical discovery of all times.

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Chagas disease was discovered by Carlos Chagas in 1909. Chagas worked at Oswaldo Cruz Institute, where the bases of experimental medicine were settled in Brazil, and that had no connection with the Faculty of Medicine of Rio de Janeiro. Chagas had several enemies at Oswaldo Cruz Institute mainly because of his election to Head of Service in 1910, and for the position of Oswaldo Cruz Directorship in 1917. Furthermore, Chagas gained enemies at Faculty of Medicine of Rio de Janeiro, which did not like to see the economical political autonomy of Oswaldo Cruz Institute. This allowed the Institute not only to perform top experimental research, but also to take the leadership of research in the country. Chagas was nominated to the Nobel Prize of 1921 in December, 1920. None was awarded the Nobel Prize in that year. He seems to have been evaluated by the Noble Committee of Karolinska Institute from March to May of 1921. At that time, his enemies were denying his discovery of Trypanosoma cruzi, a key point in Chagas' nomination by Karolinska Institute, and giving no epidemiological importance for the disease. By the same way, the obligation of small pox vaccination was tarnishing his public image. Having taken into account the epidemiologic importance of Chagas disease, the strong historical mistake in the process of Chagas evaluation, and the inequity behind all these facts, we insist on a posthumous Nobel Prize for the man who made the most complete medical-scientist discovery of all time.

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BACKGROUND: Chagas cardiomyopathy and ischemic heart disease (IHD) are frequent causes of chronic systolic heart failure (CHF) in areas where the former is endemic. Nonetheless, a specific comparison of outcome and role of etiology of CHF failure has not been performed in patients with both conditions. METHODS: Two-hundred twenty two patients with Chagas cardiomyopathy and 79 with IHD with CHF were included in the study. A Cox proportional hazards model was used to establish independent predictors of mortality for the studied population. Survival analysis was performed with the Kaplan-Meir product limit method. RESULTS: In the multivariable model, Beta-Blocker therapy [(hazard ratio (HR)=0.36; 95% confidence interval (CI) 0.24 to 0.52; p<0.005)], Chagas etiology of CHF (HR=3.6; 95% CI 2.0 to 6.5; p<0.005), serum sodium levels (HR=0.95; 95% CI 0.91 to 0.98; p<0.005), digoxin use (HR=2.1; 95% CI 1.19 to 3.80, p=0.01), and spironolactone use (HR=1.7; 95% CI 1.10 to 2.80; p=0.02) were determined independent predictors of all-cause mortality for this cohort. Probability of survival at 12, 24, 36, 48, and 60 months was 92%, 92%, 88%, 81%, and 78%, respectively, in IHD patients, and 79%, 61%, 49%, 41%, and 35%, respectively, in Chagas cardiomyopathy patients (p<0.005). CONCLUSION: Outcome in patients with chronic systolic heart failure secondary to Chagas cardiomyopathy is poorer than that seen in those with IHD.

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Chagas disease is the principal cause of chronic heart failure in areas where the disease is endemic. The medical treatment is the same recommended for non-Chagas disease patients. There is no evidence-based medicine support for device therapy in Chagas disease heart failure. Cardiac resynchronization therapy is recommended for Chagas disease heart failure patients with intraventricular conduction disturbances, mainly for those with left bundle branch block, and in advanced congestive heart failure refractory to targeted medical treatment, although this therapy is still polemic in Chagas disease heart failure. Implantable cardioverter-defibrillator (ICD) therapy is indicated to Chagas disease patients with left ventricular ejection fraction <30% for primary prevention of sudden cardiac death. ICD therapy is offered to patients for secondary prevention of sudden cardiac death. Patients with moderate left ventricular dysfunction and inducible arrhythmia at electrophysiological testing should receive ICD therapy.

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A Síndrome do QT longo (SQTL) congênito é uma doença dos canais iônicos cardíacos que está associada com síncope, taquiarritmias ventriculares e morte súbita cardíaca em pacientes com coração normal. Raramente, apresenta-se com Bloqueio Atrioventricular 2:1, apresentando mortalidade maior que 50% nos primeiros seis meses de vida, mesmo com tratamento adequado. O caso aqui descrito relata a evolução clínico de lactente com 6 meses de idade com SQTL congênito, síncope de repetição e BAV 2:1 inicialmente tratado como epilepsia, que após tratamento clínico adequado com mudança de estilo de vida, betabloqueadores e implante de marcapasso, não apresentou mais eventos cardíacos. No seguimento tardio (com 6 anos de vida), foi implantado Cardiodesfibrilador Implantável, sem terapias até a presente data.

Congenital long QT syndrome is a disease of cardiac ion channels that is associated withs yncope, cardiac sudden death and ventricular tachyarrhythmias in patients with normal hearts. Rarely,it presents associated with 2:1 atrioventricular block; in this case the mortality rate is higher than 50% in the first six months of life even with adequate treatment. The case described here reports on the clinical evolution of a six-month-old infant with congenital long QT syndrome, syncope of repetition and 2:1 atrioventricular block initially treated as epilepsy, that after the correct clinical treatment with changes in lifestyle, beta-blockers and pacemaker implantation, did not have further cardiac events. In the long term follow-up (six years of life), a defibrillator was implanted without the need of further therapies todate.

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A síndrome do QT longo (SQTL) congênito é uma doença dos canais iônicos cardíacos que está associada com síncope, taquiarritmias ventriculares e morte súbita cardíaca em pacientes com coração normal. Raramente, apresenta-se com boqueio atrioventricular 2:1, apresentando mortalidade maior que 50% nos primeiros 6 meses de vida, mesmo com tratamento adequado. O caso aqui descrito relata a evolução clínico de lactente com 6 meses de idade com SQTL congênito, síncope de repetição e BAV 2:1 inicialmente tratado como eplepsia, que após tratamento clínico adequado com mudança de estilo de vida, betabloqueadores e implante de marca-passo, não apresentou mais eventos cardíacos. No seguimento tardio (com 6 anos de vida), foi implantado cardiodesfibrilador implantável, sem terapias até a presente data.

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The Serra-Dória procedure has been used in the treatment of advanced or relapsed megaesophagus due to Chagas disease. Little is known, however, about cardiovascular complications following this procedure. The purpose of this study was to settle independent predictors of cardiovascular complications following the Serra-Dória procedure in patients with megaesophagus secondary to chronic Chagas disease. A total of 76 patients who underwent the Serra-Dória operation for Chagas disease megaesophagus from 1998 to 2010 were included. A multivariate stepwise logistic regression analysis was performed to identify predictors of cardiovascular complications. Mean age was 61±10 years; 55% were male. Advanced megaesophagus (grades III/IV) were found in 65 (86%) of patients. Twenty-two (29%) patients had one comorbidity, and five (7%) three co-morbidities before operation. Two (3%) patients died following the operation. Twenty-nine (38%) patients presented cardiovascular complication following the Serra-Dória procedure; 15 (44%) were mild, 7 (21%) moderate, and 12 (35%) severe. Age>61 years was the only independent predictor of cardiovascular complication following Serra-Dória procedure. In patients with megaesophagus secondary to chronic Chagas disease, the Serra-Dória procedure is associated with a low mortality rate and a high frequency of cardiac complication.

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FUNDAMENTO: A Hipertensão Arterial Sistêmica (HAS) é importante causa de Insuficiência Cardíaca sistólica Crônica (ICC) em países em desenvolvimento. Seria necessário conhecerem-se os fatores de predição de mortalidade para pacientes com essa condição clínica para melhor tratamento científico. OBJETIVO: Determinar os fatores de risco de mortalidade geral em pacientes com ICC secundária à HAS na era moderna do tratamento da ICC por disfunção sistólica do ventrículo esquerdo. MÉTODOS: Todos os pacientes rotineira e prospectivamente tratados na Clínica de Cardiomiopatia em nossa instituição de janeiro de 2000 a abril de 2008 com o diagnóstico de ICC secundária à HAS foram selecionados para o estudo. O modelo de riscos proporcionais de Cox foi utilizado para o estabelecimento de fatores de predição independentes de mortalidade geral. RESULTADOS: Cento e trinta pacientes foram estudados; 74 (57 por cento) eram homens. Trinta e um (24 por cento) pacientes faleceram; cinco (4 por cento) submeteram-se a transplante cardíaco; e 94 (72 por cento) estavam vivos ao final do estudo. A probabilidade de sobrevivência aos 12, 24, 36, 48 e 60 meses foi de 96 por cento, 93 por cento, 84 por cento, 79 por cento e 76 por cento, respectivamente. Idade (Razão de Riscos = 1,05, Intervalo de Confiança 95 por cento de 1,01 a 1,08, p = 0,01), dimensão diastólica do ventrículo esquerdo (Razão de Riscos = 1,08; Intervalo de Confiança 95 por cento de 1,02 a 1,09; p = 0,003) e terapia com betabloqueador (Razão de Riscos = 0,41; Intervalo de Confiança 95 por cento de 0,19 a 0,86; p = 0,02) foram os fatores de predição independentes de mortalidade geral. CONCLUSÃO: Idade, dimensão diastólica do ventrículo esquerdo e não uso de betabloqueador são fatores de predição independentes de mortalidade geral em pacientes com ICC sistólica secundária à HAS na população estudada.

BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57 percent) were male. Thirty one (24 percent) patients died, 5 (4 percent) underwent heart transplantation, and 94 (72 percent) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96 percent, 93 percent, 84 percent, 79 percent, and 76 percent, respectively. Age (Hazard Ratio=1,05, 95 percent Confidence Interval 95 percent 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95 percent Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95 percent Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.

BUNDAMENTO: La Hipertensión Arterial Sistémica (HAS) es importante causa de Insuficiencia Cardíaca sistólica Crónica (ICC) en países en desarrollo. Sería necesario conocer los factores de predicción de mortalidad para pacientes con esa condición clínica para mejor tratamiento científico. OBJETIVO: Determinar los factores de riesgo de mortalidad general en pacientes con ICC secundaria a la HAS en la era moderna del tratamiento de la ICC por disfunción sistólica del ventrículo izquierdo MÉTODOS: Todos los pacientes rutinaria y prospectivamente tratados en la Clínica de Cardiomiopatía en nuestra institución de enero de 2000 a abril de 2008 con diagnóstico de ICC secundaria a la HAS fueron seleccionados para el estudio. El modelo de riesgos proporcionales de Cox fue utilizado para el establecimiento de factores de predicción independientes de mortalidad general. RESULTADOS: Ciento treinta pacientes fueron estudiados; 74 (57 por ciento) eran hombres. Treinta y un (24 por ciento) pacientes fallecieron; cinco (4 por ciento) se sometieron a transplante cardíaco; y 94 (72 por ciento) estaban vivos al final del estudio. La probabilidad de supervivencia a los 12, 24, 36, 48 y 60 meses fue de 96 por ciento, 93 por ciento, 84 por ciento, 79 por ciento y 76 por ciento, respectivamente. Edad (Razón de Riesgos = 1,05, Intervalo de Confianza 95 por ciento de 1,01 a 1,08, p = 0,01), dimensión diastólica del ventrículo izquierdo (Razón de Riesgos = 1,08; Intervalo de Confianza 95 por ciento de 1,02 a 1,09; p = 0,003) y terapia con betabloqueante (Razón de Riesgos = 0,41; Intervalo de Confianza 95 por ciento de 0,19 a 0,86; p = 0,02) fueron los factores de predicción independientes de mortalidad general. CONCLUSIÓN: Edad, dimensión diastólica del ventrículo izquierdo y no uso de betabloqueante son factores de predicción independientes de mortalidad general en pacientes con ICC sistólica secundaria a la HAS en la población estudiada.

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BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57%) were male. Thirty one (24%) patients died, 5 (4%) underwent heart transplantation, and 94 (72%) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96%, 93%, 84%, 79%, and 76%, respectively. Age (Hazard Ratio=1,05, 95% Confidence Interval 95% 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95% Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95% Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.

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FUNDAMENTO: Pouco se sabe sobre o desfecho dos pacientes com cardiopatia chagásica, em comparação aos pacientes com miocardiopatia dilatada idiopática na era contemporânea. OBJETIVO: Comparar o desfecho dos pacientes chagásicos com insuficiência cardíaca sistólica crônica decorrente da cardiopatia chagásica ao observado em pacientes com MDI na era contemporânea. MÉTODOS: Foi incluído um total de 352 pacientes (246 com cardiomiopatia chagásica e 106 com miocardiopatia dilatada idiopática), seguidos prospectivamente em nossa Instituição, de janeiro de 2000 a janeiro de 2008. Todos os pacientes receberam tratamento clínico contemporâneo padrão. RESULTADOS: Na análise multivariada com o modelo de risco proporcional de Cox, o uso da digoxina (relação de risco = 3,17; intervalo de confiança de 95 por cento, de 1,62 a 6,18; p = 0,001) necessitou de suporte inotrópico (relação de risco = 2,08; intervalo de confiança de 95 por cento, de 1,43 a 3,02; p < 0,005). A fração de ejeção do ventrículo esquerdo (relação de risco = 0,97; intervalo de confiança de 95 por cento, de 0,95 a 0,99; p < 0,005) e a etiologia da cardiopatia chagásica (relação de risco = 3,29; intervalo de confiança de 95 por cento, de 1,89 a 5,73; p < 0,005) foram associadas positivamente à mortalidade, enquanto a terapia com betabloqueadores (relação de risco = 0,39; intervalo de confiança de 95 por cento, de 0,26 a 0,56; p < 0,005) foi associada negativamente à mortalidade. A probabilidade de sobrevida para pacientes com cardiomiopatia chagásica em oito, 24 e 49 meses foi de 83 por cento, 61 por cento e 41 por cento, respectivamente. Já para pacientes com cardiomiopatia dilatada idiopática, foi de 97 por cento, 92 por cento e 82 por cento, respectivamente (p < 0,005). CONCLUSÃO: Na era atual do tratamento da insuficiência cardíaca, os pacientes com cardiomiopatia chagásica têm um desfecho pior em comparação aos pacientes com cardiomiopatia dilatada idiopática.

BACKGROUND: Little is known about the outcome of patients with Chagas cardiomyopathy in comparison to that of patients with Idiopathic Dilated Cardiomyopathy in the contemporary era. OBJECTIVE: To compare the outcome of chagasic patients with chronic systolic heart failure secondary to Chagas cardiomyopathy with that observed in patients with IDC in the contemporary era. METHODS: A total of 352 patients (246 with Chagas cardiomyopathy, 106 with Idiopathic Dilated Cardiomyopathy) prospectively followed at our Institution from January, 2000 to January, 2008 were included. All patients received standard contemporary medical therapy. RESULTS: In Cox proportional hazards model multivariate analysis, digoxin use (Hazard Ratio=3.17; 95 percent Confidence Interval 1.62 to 6.18; p=0.001), need of inotropic support (Hazard Ratio=2.08; 95 percent Confidence Interval 1.43 to 3.02; p<0.005), left ventricular ejection fraction (Hazard Ratio=0.97; 95 percent Confidence Interval 0.95 to 0.99; p<0.005), and Chagas cardiomyopathy etiology (Hazard Ratio=3.29; 95 percent Confidence Interval 1.89 to 5.73; p<0.005) were positively associated with mortality, whereas Beta-Blocker therapy (Hazard Ratio=0.39; 95 percent Confidence Interval 0.26 to 0.56; p<0.005) was negatively associated with mortality. Survival probability for patients with Chagas cardiomyopathy at 8, 24, and 49 months was 83 percent, 61 percent, and 41 percent, respectively, and for patients with Idiopathic Dilated cardiomyopathy 97 percent, 92 percent, and 82 percent, respectively (p<0.005). CONCLUSION: In the current era of heart failure therapy, patients with Chagas cardiomyopathy have a poorer outcome in comparison to patients with Idiopathic Dilated Cardiomyopathy.

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