Efeitos da otimização terapêutica da insuficiência cardíaca em chagásicos com miocardiopatia dilatada

Abstract

For this prospective study a group of 42 patients with dilated cardiomyopathy caused by Chagas disease. The selection was made consecutively among patients assisted on the Ambulatório de Referência em Doença de Chagas do Hospital das Clínicas da UFMG (Reference Ambulatory for Chagas Disease of the Teaching County Hospital of theFederal University of Minas Gerais). The protocol of optimizing of dosage of enalapril (20 mg BID) and spironolactone (25 mg MID) was applied to the selected group, according to the guideline of great therapeutic clinical trials on secondary cardiac insufficiency to dilated cardiomyopathies of non - Chagas Disease etiology. The utilization of other medicaments, such as furosemide, hidroclorotiazidics, digoxin and amiodarone wereguided in accordance to clinical requirement, respecting their basic indications and restrictions. These patients behaviors were assessed, under clinical, life quality, radiological and ECG aspects before and after optimized treatment with appropriate and maximized doses. Laboratorial tests were run on all the patients hepatic, renal, hematological and ionic functions before an after the treatment optimizing. Radiological and ECG evaluations were also performed in the beginning and at the end of each stage of the study. The premise used for the selection was the presence of the left ventricle diastolic diameter (LVD) larger than 55mm, or 2,7 cm / m2 or ejection fraction (EF) minor than 55% (modified Simpson). Patients with any co - morbidities, which might have caused confusion to the data analysis, were excluded. It was observed, for an average period of119 days, that the therapeutic optimizing was safe and efficient, being characterized by a meaningful improvement on the clinical examination (scale of ICC p = 0,0004), in the life quality (domains: functional capacity p = 0,032, physical limitation p = 0,001, pain perception p= 0,040, general health status p = 0,0006 and emotional aspects p = 0,032), in the radiological parameters (reduction in the cardiothoraxic index p = 0,002) and ECG (improvement of the index TEI p = 0,013). On the analysis of the differences of the EF (p = 0,249) and of the LVD (p = 0,335) between the two stages, statistic significance was not observed. However, when the patients were rated according to the degree of systolic dysfunction (EF < = 45%) a significant difference was observed (p =0,017) between the two variables prior and after the optimized treatment. It was concluded that the therapeutic model with optimized doses of enalapril and spironolactone was safe and efficient on patients with dilated cardiomyopathy caused by Chagas disease and cardiac insufficiency.