Document Detail


Beta-blocker therapy and mortality of patients with Chagas cardiomyopathy: a subanalysis of the REMADHE prospective trial.
MedLine Citation:
PMID:  19933408     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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; F?tima D Cruz; Silvia M A Ferreira; Guilherme V Guimar?es; Paulo R Chizzola; Germano E C Souza; Fernando Bacal; Edimar A Bocchi
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Publication Detail:
Type:  Journal Article     Date:  2009-11-20
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-20     Completed Date:  2010-02-16     Revised Date:  2010-05-21    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  82-8     Citation Subset:  IM    
Affiliation:
Heart Failure Institute do Hospital das Cl?nicas da Faculdade de Medicina da Universidade de S?o Paulo, S?o Paulo, Brazil. victor.issa@incor.usp.br
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00505050
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MeSH Terms
Descriptor/Qualifier:
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
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comments/Corrections
Comment In:
Circ Heart Fail. 2010 May 1;3(3):e11; author reply e15   [PMID:  20484185 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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