Increased Morbidity in Chagas Cardiomyopathy Patients Compared to Other Nonischemic Cardiomyopathy Patients in US-Based Population

Abstract

Chagas disease (CD) is the leading cause of cardiomyopathy in Latin America and is believed to infect 16-18 million people. Given recent immigration trends in the United States, there is a large population at risk. Recent data suggests that a high prevalence (17.2%) of Chagas cardiomyopathy in Latino immigrants. However, little data exists on the morbidity of these patients in a US-based population. 124 consecutive Latino immigrants with cardiomyopathy at a Los Angeles County hospital were prospectively followed. Inclusion criteria were ejection fraction <40%, nonischemic etiology of cardiomyopathy, and residence in Latin America for at least 12 months in the past. At enrollment, all patients had Chagas titers drawn. 22 patients had Chagas disease (CD) with 102 patients in the non Chagas group (NC). Baseline characteristics are listed in Table 1.Table 1Patient characteristicsChagas (n = 22)Non Chagas (n = 102)p ValueAge57.5550.155Gender (male)50%59%0.480Ejection Fraction21.9%24.8%0.163LVEDD (mm)66.562.00.209Beta Blocker90.9%93.1%0.660ACEI/ARB90.9%89.2%0.743Spironolactone31.8%28.4%0.798ICD use36%8%0.002 Open table in a new tab Median follow up was similar in both groups 20.3 and 22.8 months. The primary endpoints were congestive heart failure (CHF) hospitalization rate and percent free of CHF hospitalization. During follow up there were 22 hospitalizations in 10 patients in the Chagas group and 50 hospitalizations in 26 patients in the non-Chagas group. The hospitalization rate in the Chagas group was 70.3 + /- 15 per 100 patient-years of follow-up. The rate in the non-Chagas group was 27.2 + /- 3.9 per 100 patient-years (p = 0.0223). The hospitalization rate ratio was 2.58. The percent free of hospitalization was 67.1% + /- 10.3% at 1 year and 54.7% + /- 11.6% at 2 years in the Chagas group. The percent free of hospitalization was 79.7% + /- 4.1% at 1 year and 74.4% + /- 4.6% at 2 years in the non-Chagas group (p = 0.0432). The hospitalization-free ratio was 2.07. This study demonstrates a significant increase of CHF-related hospitalizations and patients requiring hospitalization with Chagasic cardiomyopathy. This highlights the importance of identifying Chagas disease as a prevalent etiology of nonischemic cardiomyopathy in a Latino immigrant population and is a poor prognostic marker.