Abstract 13256: Prognosis of Congestive Heart Failure Due to Chagas Disease in Women and Men

Abstract

Introduction: Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of congestive heart failure (CHF) in Latin America and carries a high morbidity and mortality burden. Previously, it was believed that there was no epidemiological and clinical evidence of a gender-associated risk of death in patients with CCC. Hypothesis: to analyze the mortality of congestive heart failure due to CCC in women and men. Methods: From February 2017 to September 2020, we followed a cohort of patients with CHF due to CCC in a single-center outpatient clinic. Serologic tests defined Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier method and Cox proportional hazards methods. Results: We studied 733 patients, mean of 61.4 ± 12.3 years, and 381 (52%) males. At baseline, women were older (63.0±11.9 vs. 60±12.4 years; p=0.01), had a higher prevalence of CKD (9.7 vs. 5.1%; p=0.002), higher mean left ventricular ejection fraction (LVEF) (44.5±14.6% vs. 37.3±14.8%; p<0.001), and a lower left ventricular diastolic diameter (LVDD) (56.7±8.9 vs. 62.4±9.4 mm; p<0.001). Over a 3-years follow-up period, 294 patients died being 168 (57%) men and 126 (43%) women (log-rank; p=0.002). Women had more implantable pacemakers (26.1% vs. 16.5%; p=0.002) and men more implantable cardioverter-defibrillators (20.7% vs. 12.5%; p=0.003). Heart transplants occurred in 10.8% of men and 7.4% of women (p=NS). Cox regression for death adjusted for age, sex, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, and LVEF showed men (HR=1.4; 95%CL:1.1-1.8), previous stroke (HR=2.4; 95%CL:1.5-3.6), diabetes (HR=2.0; 95%CL: 1.3-3.1), and CKD (HR=1.8; 95%CL:1.3-2.6) as the main predictors of death. Conclusions: women had a better prognosis than men. Treatment of comorbidities will significantly reduce the death rate in CHF due to CCC.