Impacto da hipertensão arterial sistêmica na evolução clínica de pacientes com insuficiência cardíaca crônica sistólica associada à doença de Chagas

Abstract

The aim of the present study was to compare the clinical course of patients with chronic systolic heart failure secondary to Chagas disease with that of patients with chronic systolic heart failure due to Chagas disease and SAH (Chagas-SAH). Methods: The study population comprised 353 patients (246 with Chagas disease and 107 with Chagas-SAH) with chronic systolic hart failure routinely and prospectively followed at our institution from January 2000 to April 2008. Results: In the Cox proportional hazards model multivariate analysis, Chagas etiology of heart failure [Hazard Ratio (HR)=4,45; 95% Confidence Interval (CI) 2,54 to 7,79; p<0,005)], left ventricular systolic diameter (HR=1,04; 95% CI 1,02 to 1,06; p<0,005), need of inotropic support (HR=1,97; 95% CI 1,36 to 2,85; p< 0,005), and Spironolactone use (HR=1,68; 95% CI 1,03 to 2,74; p=0,04) were positively associated, whereas Beta-Blocker therapy (HR=0,35; 95% CI 0,24 to 0,51; p<0,005) was negatively associated with all-cause mortality. In Chagas disease patients, survival probability was 74%, 55%, 44%, 36%, and 30% at 12 , 24, 36, 48, and 60 months, respectively. By contrast, in patients with Chagas-SAH, survival probability was 98%, 95%, 88%, 82%, and 74%, at 12, 24, 36, 48, and 60 months, respectively, (p <0,005). Conclusions. Patients with Chagas-SAH have a better outcome than Chagas disease patients without SAH.