Comparison of outcome between Chagas cardiomyopathy and idiopathic dilated cardiomyopathy.

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% Confidence Interval 1.62 to 6.18; p=0.001), need of inotropic support (Hazard Ratio=2.08; 95% Confidence Interval 1.43 to 3.02; p<0.005), left ventricular ejection fraction (Hazard Ratio=0.97; 95% Confidence Interval 0.95 to 0.99; p<0.005), and Chagas cardiomyopathy etiology (Hazard Ratio=3.29; 95% Confidence Interval 1.89 to 5.73; p<0.005) were positively associated with mortality, whereas beta-blocker therapy (Hazard Ratio=0.39; 95% 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%, 61%, and 41%, respectively, and for patients with idiopathic dilated cardiomyopathy 97%, 92%, and 82%, 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.