Beta-blocker therapy and mortality of patients with Chagas cardiomyopathy: a subanalysis of the REMADHE prospective trial.

Abstract

BACKGROUND:

Peculiar aspects of Chagas cardiomyopathy raise concerns about efficacy and safety of sympathetic blockade. We studied the influence of beta-blockers in patients with Chagas cardiomyopathy.

METHODS AND RESULTS:

We examined REMADHE trial and grouped patients according to etiology (Chagas versus non-Chagas) and beta-blocker therapy. Primary end point was all-cause mortality or heart transplantation. Altogether 456 patients were studied; 27 (5.9%) were submitted to heart transplantation and 202 (44.3%) died. Chagas etiology was present in 68 (14.9%) patients; they had lower body mass index (24.1+/-4.1 versus 26.3+/-5.1, P=0.001), smaller end-diastolic left ventricle diameter (6.7+/-1.0 mm versus 7.0+/-0.9 mm, P=0.001), smaller proportion of beta-blocker therapy (35.8% versus 68%, P<0.001), and higher proportion of spironolactone therapy (74.6% versus 57.8%, P=0.003). Twenty-four (35.8%) patients with Chagas disease were under beta-blocker therapy and had lower serum sodium (136.6+/-3.1 versus 138.4+/-3.1 mEqs, P=0.05) and lower body mass index (22.5+/-3.3 versus 24.9+/-4.3, P=0.03) compared with those who received beta-blockers. Survival was lower in patients with Chagas heart disease as compared with other etiologies. When only patients under beta-blockers were considered, the survival of patients with Chagas disease was similar to that of other etiologies. The survival of patients with beta-blockers was higher than that of patients without beta-blockers. In Cox regression model, left ventricle end-diastolic diameter (hazard ratio, 1.78; CI, 1.15 to 2.76; P=0.009) and beta-blockers (hazard ratio, 0.37; CI, 0.14 to 0.97; P=0.044) were associated with better survival.

CONCLUSIONS:

Our study suggests that beta-blockers may have beneficial effects on survival of patients with heart failure and Chagas heart disease and warrants further investigation in a prospective, randomized trial. Clinical Trial Registration- clinicaltrials.gov. Identifier: NCT00505050.

• Authors: Victor S Issa, Alexandre F Amaral, Fátima D Cruz, Silvia M A Ferreira, Guilherme V Guimarães, Paulo R Chizzola, Germano E C Souza, Fernando Bacal, Edimar A Bocchi
• Journal: Circulation. Heart failure (Circ Heart Fail) Vol. 3 Issue 1 Pg. 82-8 (Jan 2010) ISSN: 1941-3297 [Electronic] United States
• PMID: 19933408 (Publication Type: Journal Article)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Body Mass Index
• Chagas Cardiomyopathy (drug therapy, mortality)
• Female
• Heart Failure (drug therapy, mortality)
• Humans
• Male
• Middle Aged
• Randomized Controlled Trials as Topic
• Retrospective Studies
• Treatment Outcome