Impacto do tratamento com benzonidazol na função ventricular esquerda aferida pelo strain bidimensional em pacientes com doença de Chagas

Abstract

Background: Benznidazole is the drug of choice for treating acute cases of Chagas disease, but its use in the chronic form is still controversial. This study aims to evaluate the impact of specific antiparasitic treatment with benznidazole on left ventricular function through global longitudinal strain (GLS).

Methods: In this prospective study, 67 patients with serologically confirmed Chagas disease and no evidence of severe cardiomyopathy were enrolled. All patients underwent transthoracic echocardiography with assessment of GLS and electrocardiography, followed by antiparasitic treatment with benznidazole (300 mg/day for 60–80 days). Repeat examinations were performed 6 months after treatment completion. GLS improvement was defined as an increase of more than 15% from baseline. Multivariate logistic regression analysis was conducted to identify predictors of GLS improvement.

Results: While conventional echocardiographic parameters and electrocardiographic findings remained unchanged after treatment, a significant improvement in GLS was observed, with mean values increasing from –16.9 ± 3.0% at baseline to –18.5 ± 3.1% at six-month follow-up (p < 0.001). A GLS improvement exceeding 15% from baseline was noted in 39% of patients. Multivariate analysis identified lower indexed left atrial volume (OR 0.860, 95% CI 0.772–0.957, p = 0.006) and higher septal e′ velocity (OR 0.640, 95% CI 0.471–0.871, p = 0.004) as independent predictors of GLS improvement.

Conclusion: Treatment with benznidazole in patients with Chagas disease without severe heart disease was associated with a subclinical improvement in left ventricular function assessed by GLS. Randomized clinical trials are needed to assess whether this improvement translates into improved clinical outcomes.