Background: Chagas disease is a major health issue in Latin America and is now spreading globally because of migration. Chronic Chagasic cardiomyopathy (CCC) leads to heart failure with a reduced ejection fraction (HFrEF). Left ventricular reverse remodeling (LVRR), defined as an improved LVEF, is associated with improved outcomes in patients with other HFrEF etiologies. Therefore, we evaluated the relationship between LVRR and survival in CCC patients with an LVEF<40%.

Methods: This retrospective, single-center study included patients diagnosed with CCC and LVEF<40% between January 2006 and September 2021. Patients were divided into two groups: positive RR (PRR; LVEF≥40% or an absolute LVEF increase of ≥ 10%) and negative RR (NRR). Propensity score matching (PSM) was used to account for baseline differences, and Cox proportional hazards models were applied to determine independent predictors of mortality and heart transplantation.

Results: A total of 1,043 patients were evaluated; 221 (21.2%) were classified as having PRR, and 822 (78.8%) were classified as having NRR. PRR status was associated with a 55% lower risk of all-cause mortality and heart transplantation over 15 years (p = 0.002). Multivariate Cox analysis revealed that predictors of total mortality and heart transplantation included NRR status, a worse NYHA class, lower serum sodium levels, larger LV dimensions, and moderate-to-severe tricuspid regurgitation (TR). The PRR predictors were smaller LV dimensions, less mitral regurgitation, and the absence of triple therapy at baseline. NRR patients were more likely to be on triple therapy at baseline.

Conclusions: PRR improves survival in CCC patients with HFrEF. Identifying patients with potential for LVRR, alongside early therapeutic interventions, may reduce mortality in this population. Future research should focus on therapies that promote LVRR in patients with CCC.

Copyright: © 2025 Lira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

背景： 美洲锥虫病是拉丁美洲的一个主要健康问题，并且由于移民的原因，该疾病正在全球范围内扩散。慢性美洲锥虫病性心肌病（CCC）会导致射血分数降低的心力衰竭（HFrEF）。左心室逆向重构（LVRR），定义为左心室射血分数的改善，与由其他原因引起的 HFrEF 患者的预后改善有关。因此，我们评估了 LVRR 与 CCC 患者生存率之间的关系。

方法： 这项回顾性单中心研究纳入了在2006年1月至2021年9月期间被诊断为CCC且射血分数小于40%的患者。将患者分为两组：正向重构（PRR；射血分数≥40%或射血分数绝对增加≥10%）和非正向重构（NRR）。使用倾向评分匹配（PSM）来考虑基线差异，并应用Cox比例风险模型以确定独立的死亡率和心脏移植预测因素。

结果： 共评估了 1,043 名患者；其中221名（21.2%）被分类为具有 PRR，822 名（78.8%）被分类为具有 NRR。PRR 状态与15年内所有原因死亡率和心脏移植的风险降低55%相关（p = 0.002）。多变量Cox分析显示，总死亡率和心脏移植的预测因素包括NRR状态、更差的心功能NYHA分级、更低的血清钠水平、更大的左心室尺寸以及中至重度三尖瓣反流（TR）。而PRR 的预测因素则为较小的左心室尺寸、较少的二尖瓣反流，和基线时缺乏三联疗法。NRR 患者更可能在基线时使用三联疗法。

结论： 对于 HFrEF 的 CCC 患者来说，PRR 可以改善其生存率。识别具有 LVRR 潜力的患者，并进行早期治疗干预可以降低这一群体的死亡率。未来的研究应集中在促进 CCC 患者LVRR 的疗法上。

版权：© 2025 Lira 等人。本文章根据知识共享署名许可协议发布，在此许可下，只要注明原作者和出处，可以自由使用、分发和复制任何形式的作品。