Clinical InvestigationCongestive Heart FailureA randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy
Section snippets
Study patients
The study was approved by the Federal University of Minas Gerais Research Ethics Board. All patients gave their written informed consent. Criteria for inclusion were positivity for T cruzi as confirmed by 2 or more serological tests (indirect immunofluorescence, ELISA, and/or indirect hemagglutination) and having cardiomyopathy. Cardiomyopathy was present when at least 3 of the following criteria were fulfilled: LV end-diastolic diameter (LVDD) >55 mm; LVDD/body surface area >2.7cm/m2; LV
Patients
Of the 42 patients initially recruited, 39 completed phase I and 36 completed phase II. Three patients were lost in phase 1, each because of sudden death, poorly controlled ventricular tachycardia, and noncompliance. Of the 39 patients who entered phase II, 20 were randomized to receive placebo and 19 were randomized to receive carvedilol. Two patients from the placebo group were lost, each because of death caused by intractable HF and intolerable symptoms. One patient from the carvedilol group
Discussion
Although CCC continues to be a cause of substantial morbidity and mortality in the developing world and bears similarities to other cardiomyopathies, the safety and efficacy of proven HF therapies in CCC are poorly documented. We sought to address this issue by analyzing the effects of optimizing RAS inhibition and adding carvedilol in the treatment of CCC.
Our results are consistent with those obtained in patients with non–chagasic cardiomyopathies.8, 9, 10, 11, 12 In the RAS inhibition phase,
References (36)
- et al.
Clinical course of Chagas' heart disease: a comparison with dilated cardiomyopathy
Int J Cardiol
(1997) - et al.
The role of aldosterone blockers in the management of chronic heart failure
Am J Med Sci
(2005) - et al.
A comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol or Metoprolol European Trial (COMET): randomised controlled trial
Lancet
(2003) - et al.
Acute effects of digitalis and enalapril on the neurohormonal profile of chagasic patients with severe congestive heart failure
Int J Cardiol
(1996) - et al.
Effects of metoprolol in chagasic patients with severe congestive heart failure
Int J Cardiol
(2002) Early detection by the Tei index of carvedilol-induced improved left ventricular function in patients with heart failure
Am J Cardiol
(2005)- et al.
Brain natriuretic peptide and left ventricular dysfunction in Chagas' disease
Lancet
(2002) - et al.
Brain natriuretic peptide response is heterogeneous during β-blocker therapy for congestive heart failure
J Card Fail
(2004) - et al.
Chemokines, inflammation and Trypanosoma cruzi infection
Trends Parasitol
(2002) - et al.
Effect of beta-blockers on circulating levels of inflammatory and anti-inflammatory cytokines in patients with dilated cardiomyopathy
JAAC
(2001)
Clinical management of chronic Chagas cardiomyopathy
Front Biosci
Survival and predictors of survival in patients with congestive heart failure due to Chagas' cardiomyopathy
Circulation
Doença de Chagas
Mem Inst Oswaldo Cruz
As causas anatômicas da insuficiência cardíaca na cardiopatia (Miocardite) chagásica crônica estudadas comparativamente com as causas anatômicas da insuficiência cardíaca noutras cardiopatias
Arq Cardiol
Congestive heart failure: a half century perspective
Eur Heart J
Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)
N Engl J Med
Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure
N Engl J Med
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The immunomodulatory effects of the Enalapril in combination with Benznidazole during acute and chronic phases of the experimental infection with Trypanosoma cruzi
2017, Acta TropicaCitation Excerpt :Therapy with ACE inhibitors has been effective not only in the control of hypertension and heart disease (Fontana et al., 2012) but also for the modulation of the immune system in several distinct diseases, including pathology due to T. cruzi infection (Leon et al., 2003; Paula-Costa et al., 2010; Penitente et al., 2015). Similar to the results observed in experimental T. cruzi infection, ACE inhibitors have been shown to reduce circulating inflammatory mediators in chagasic patients, and this is associated with improvement in left ventricle functionality (Botoni et al., 2007). In an experimental model, administration of 25 mg/kg enalapril in mice infected with the Colombiana strain reduced TNF and CCL5 levels but did not alter the profile of the anti-inflammatory cytokine IL-10 during the acute phase of infection (Paula-Costa et al., 2010).
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Profs F. A. Botoni, M. O .C. Rocha, M. M. Teixeira, A. L. P. Ribeiro, and A. M. Reis were supported by the CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) and CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasília, DF, Brazil). Prof P. A. Poole-Wilson and Dr D. O. Okonko were supported by the British Heart Foundation (London, UK).