Non-dilated left ventricular cardiomyopathy in patients with chronic Chagas disease and heart failure with reduced left ventricular ejection fraction.

INTRODUCTION

The aim of this investigation was to establish the clinical characteristics and outcomes of patients with non-dilated left ventricular cardiomyopathy (NDLVC) secondary to chronic Chagas disease (CChD).

METHODS

All patients with CChD followed at our institution from January 2000 to January 2010 were included. Patients with a left ventricular ejection fraction (LVEF) <50%, a left ventricular diastolic diameter (LVDD) <55 mm, and segmental wall motion abnormalities (SWMA) on echocardiography were diagnosed with NDLVC secondary to CChD. The remaining patients had dilated cardiomyopathy (DCM) secondary to CChD.

RESULTS

Of the 215 patients, 21 (10%) had NDLVC. In this group, the mean age was 62 ± 9 years, 12 (57%) were male, the median daily dose of metoprolol was 100 (62, 5, 125) mg, the LVDD was 51 ± 29 mm, and the LVEF was 39 ± 6.4%. SWMA were found in 12 (57%) patients. Mean follow-up 50.8 ± 3.8 months, during which 9 (43%) patients died. In a Cox regression model, Beta-blocker therapy was the only independent predictor of all-cause mortality for patients with NDLVC (hazard ratio = 0.16, 95% CI 0.04-0.68; P = .01) Over a 60-month follow-up, Kaplan-Meier survival estimates at 12, 24, 36, 48, and 60 months, were 71%, 71%, 59%, 59%, and 59%, respectively, in patients with NDLVC, and 77%, 61%, 49%, 38%, and 30%, respectively, in those with DCM due to CChD (P = .04).

CONCLUSIONS

Non-dilated left ventricular cardiomyopathy affects one in 10 patients with CHF due to CChD, and the 5-year survival rate is 59%.