Influence of Etiology on Heart Failure With Preserved Systolic Function Mortality in a Population With High Prevalence of Chagas Cardiomyopathy

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Abstract

Background: Heart failure with preserved systolic function is a clinical syndrome with the same signs and symptoms of classic heart failure. Chagas disease is a major cause of heart failure in Latin America, associated with dilated cardiomyopathy and progressive deterioration of systolic function. There are no previous assessment studies of patients with heart failure and preserved systolic function in an endemic area in which Chagas disease is the leading cause of heart failure.
Objective: The aim of this study was to compare clinical characteristics and evolution of heart failure in patients with systolic dysfunction and with preserved systolic function in a population with high prevalence of Chagas disease.
Methods: A prospective assessment was performed in patients with clinical diagnosis of heart failure admitted to a referral center in Salvador, Bahia (Brazil). Left ventricular ejection fraction > 45% by echocardiogram was considered as preserved systolic function. A one year follow-up was conducted through telephone or personal interview at the heart failure clinic.
Results: Three hundred and eighty three patients were included in this study over a period of 16 months; 52.5% of patients were male and average age was 54.2 years. Systolic function was preserved in 138 patients (36%). Chagas disease was the main etiology of both types of heart failure (45.3% with systolic dysfunction and 44.2% with preserved systolic function). One year follow-up was completed by 93.5% (358) of patients. Patients with Chagas disease and preserved systolic function had lower mortality than patients with systolic dysfunction (10% vs. 23.6%, p = 0.039). In patients without Chagas disease and preserved systolic function, mortality was similar to that of those with systolic dysfunction (10.4% vs. 15.8%, p = 0.307).
Conclusions: Preserved systolic function was very common in our population. Chagas disease is the leading cause of heart failure irrespective of left ventricular ejection fraction. Patients with Chagas disease and preserved systolic function have a better prognosis than those with systolic dysfunction, probably because they are in the initial phase of cardiac impairment.