Presentación, intervenciones y mortalidad de la cardiopatía chagásica, unidad de falla cardiaca, Fundación Cardioinfantil, 2016-2017

Abstract

Chagasic heart disease is an infectious disease that causes significant morbidity and mortality in our environment. It is mainly transmitted through the vector, oral and mateno-fetal routes. 10% of the Colombian population lives in an endemic area with an estimated seroprevalence of 1%. SIVIGILA reported 890 cases of chronic Chagas disease in 2016, without characterizing its clinical manifestations, treatment or mortality. It is known that this pathology has a clinical evolution different from other heart diseases, with different manifestations between the endemic regions. The treatment, for the most part, is based on studies of heart failure and ischemic heart disease. Objective: To characterize the clinical presentation, interventions, and mortality of chronic chagasic cardiopathy in a heart failure unit in a Latin American reference center. Methods: A description was made of adult patients with chronic chagasic heart disease treated in a unit specialized in heart failure, with analysis of quantitative and qualitative variables according to the distribution of the data and the results of the measures of central tendency and dispersion are shown. The presentation and association profiles were determined through a multiple correspondence analysis. To calculate the correlation with mortality, the X2 test was calculated. Results: Between 2016 and 2017, 108 patients were included, 73% were male, average age 66 years, mainly from Boyacá, Santander and Cundinamarca. Comorbidities such as hypertension, chronic kidney disease, dyslipidemia, and diabetes Mellitus were present in 48, 24, 16 and 14%, respectively. Heart failure is the manifestation in 84%, with functional class greater than NYHA> I in 70%. They presented a high frequency of arrhythmias such as atrial fibrillation and ventricular ectopias in addition to thromboembolic events. The mean left ventricular ejection fraction (LVEF) at diagnosis was 28% (SD 11.9); with a tendency to improve LVEF with interventions in the group with LVEF less than 25% and a decrease in the group with LVEF greater than 35%. Most are found with disease-modifying and anticoagulant treatment. The implant of devices for primary and secondary prevention of sudden death and cardiac resynchronization therapy was presented in 81%. 5% have received a heart transplant. The grouping is observed in two profiles; the first with a patient in a worse functional class with low LVEF and the second with patients with arrhythmic events and preserved LVEF. Possible mortality factors were functional class III / IV, the presence of ventricular premature beats, lower LVEF, and greater than 8% decrease in LVEF during follow-up. Conclusions: Heart failure of chagasic origin in our cohort is more frequent in men from Boyaca, Cundinamarca, and Santander; it manifests mainly as heart failure, with comorbidities expected for age. There is a greater frequency of ventricular and atrial arrhythmias compared to other heart diseases, even to other populations of Chagasic heart disease. This is associated with greater thrombotic events, the use of anticoagulants and devices for the prevention of sudden death. Adherence to optimal medical treatment based on evidence was observed. Factors associated with mortality were lower LVEF and greater than 8% decrease in LVEF during follow-up.