Abstract 3919: Beta-Blocker Therapy and Mortality of Patients With Chagas’ Cardiomyopathy: A Subanalys of the Remadhe Prospective Trial
Background. Peculiar aspects of Chagas cardiomyopathy raise concerns about efficacy and safety of sympathetic blockade. We studied the influence of beta-blockers in patients with Chagas cardiomyopathy.
Methods and results. We examined REMADHE prospective trial and grouped patients according to etiology (Chagas vs non-Chagas) and beta-blocker therapy. Primary end-point was all-cause mortality/heart transplantation. Altogether 456 patients were studied; 27 (5.9%) were submitted to heart transplantation and 202 (44.3%) died. Chagas etiology was present in 68 (14.9%) patients. Twenty-four (35.8%) Chagas patients were under betablocker therapy and had lower serum sodium level (136.6±3.1 mEqs vs 138.4±3.1 mEqs, p=0.05) and lower body mass index (22.5±3.3 vs 24.9±4.3, p=0.03) compared to those who received beta-blockers. Survival rate was lower in patients with Chagas heart disease as compared to other etiologies. When only patients under beta-blockers were considered, the survival of patients with Chagas was similar to that of other etiologies. The survival of patients with beta-blockers was higher than that of patients without beta-blockers. In Cox proportional-hazards regression model left ventricle end-diastolic diameter (HR 1.78; CI 1.15–2.76; p=0.009) and beta-blockers (HR 0.37; CI 0.14 – 0.97; p=0.044) were associated with better survival.
Conclusions. This is the first report on the beneficial influence of beta-blockers on mortality of patients with Chagas heart disease, based on prospective data.