Abstract 17782: Reverse Remodeling as a Survival Predictor in Chagas Cardiomyopathy

Abstract

Introduction: Chagas cardiomyopathy (CC) has a worse prognosis than other etiologies. Reverse remodeling (RR) is consistently associated with better mortality and morbidity outcomes in heart failure with reduced ejection fraction (HFrEF) of non-chagasic etiology. Still, the impact on CC has been poorly studied. Hypothesis: RR improves survival in patients with CC. Methods: From January 2006 to September 2021, the medical records of 1049 patients with positive serology for Trypansosoma cruzi infection associated with left ventricular ejection fraction (LVEF) <40% were reviewed. RR was defined as a 10% absolute increase in LVEF or absolute LVEF > 40% on the second echocardiogram. Participants were divided into 2 groups: negative RR (NRR) and positive RR (PRR). Results: 221 patients had PRR and 828 NRR. At baseline, the median age in the PRR group was 59 years versus 56 years in the NRR (p <0.001), with 48.2% males in the RRP group versus 58.9% in the RRN (p 0.005). Regarding treatment, only the use of furosemide showed a difference (63.3% in the PRR and 75.4% in the NRR; p <0.001). Regarding baseline ECOTT: the median of LVEF was 30.5% in PRR and 29% in NRR (p <0.001), median LV Diastolic Diameter (DD) (PRR 60 mm; NRR 64mm; p <0.001); median LV Systolic Diameter (SD) (PRR 50 mm; NRR 55 mm); the presence of moderate to severe mitral insufficiency (PRR 37.8%; NRR 50.6%; p <0.001). In the second ECOTT, the PRR group had a median LVEF of 41%, LVDD of 58 mm, and LVSD of 44 mm. In both the univariate analysis and the adjustment made by the multivariate analysis by COX regression, the PRR was an independent predictor associated with all-cause death (HR 0.625, 95% CI 0.421-0.928; p 0.020). Median survival time (and 95% CI) was 8,8 (8,4-9,2) years in the NRR group and 11,4 (10,8-13,8) in the PRR group. Survival was significantly better for PRR than NRR (p <0.001, pairwise Log-Rank comparison). Conclusions: This study suggests a positive association between PRR and increased survival in patients with CHD and HFrEF. Previously published studies didn’t demonstrate this association, possibly due to the small number of patients included.