BACKGROUND Serial echocardiographic studies in chronic Chagas cardiomyopathy are scarce. The aims of this study were to evaluate whether therapy with benznidazole modifies the progression of cardiac impairment and to identify baseline echocardiographic parameters related to prognosis. METHODS A prospective substudy was conducted in 1,508 patients with chronic Chagas cardiomyopathy randomized to benznidazole or placebo, who underwent two-dimensional echocardiography at enrollment, 2 years, and final follow-up (5.4 years). Left ventricular (LV) ejection fraction, LV wall motion score index (WMSI), indexed left atrial volume, and chamber dimensions were collected and correlated to all-cause death and a composite hard outcome using univariate and multivariate analyses. RESULTS At enrollment, most patients had normal chamber dimensions, and 70.5% had preserved LV ejection fractions. During follow-up, all chamber dimensions increased similarly in both treatment arms. LV ejection fraction was comparably reduced (55.7 ± 12.7% to 52.1 ± 14.6% vs 56.3 ± 12.7% to 52.8 ± 14.1%) and LV WMSI similarly increased (1.31 ± 0.41 to 1.49 ± 0.03 and 1.27 ± 0.38 to 1.51 ± 0.03) for the benznidazole and placebo groups, respectively (P > .05). A higher baseline LV WMSI was identified in subjects who died compared with those alive at final echocardiography (1.76 ± 0.517 vs 1.271 ± 0.393, P < .0001). There was a significant (P < .0001) graded increase in the risk for the composite outcome with worsening LV WMSI (hazard ratios, 2.27 [95% CI, 1.69-3.06] and 6.42 [95% CI, 4.94-8.33]) and also of death (hazard ratios, 2.45 [95% CI, 1.62-3.71] and 8.99 [95% CI, 6.3-12.82]) for 1 < LV WMSI < 1.5 and LV WMSI > 1.5, respectively. Both LV WMSI and indexed left atrial volume remained independent predictors in multivariate analysis. CONCLUSIONS Trypanocidal treatment had no effect on echocardiographic progression of chronic Chagas cardiomyopathy over 5.4 years. Despite normal global LV systolic function, regional wall motion abnormalities and indexed left atrial volume identified patients at higher risk for hard adverse clinical outcomes.

中文翻译：

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锥虫病治疗对南美锥虫性心肌病超声心动图参数的影响和壁运动评分指数的预后价值：一项有益的超声心动图研究。

背景技术在慢性恰加斯州心肌病中的连续超声心动图研究很少。这项研究的目的是评估苯并硝唑治疗是否能改善心脏损害的进展，并确定与预后相关的基线超声心动图参数。方法对1508例慢性Chagas心肌病患者进行前瞻性亚研究，该患者随机分配给苯硝唑或安慰剂，入组时接受二维超声心动图检查，随访2年，并进行最终随访（5.4年）。收集左心室（LV）射血分数，左室壁运动评分指数（WMSI），左心房容积索引和腔室尺寸，并使用单变量和多变量分析将其与全因死亡和复合硬结局相关联。结果入组时，大多数患者的房室尺寸正常，为70。5％保留了左室射血分数。在随访期间，两个治疗臂的所有腔室尺寸均类似增加。对于苯并咪唑组和安慰剂组分别为（P> .05）。与在最终超声心动图检查中存活的受试者相比，在死亡受试者中确定了更高的基线LV WMSI（1.76±0.517 vs 1.271±0.393，P <.0001）。LV WMSI恶化（风险比为2.27 [95％CI，1.69-3.06]和6.42 [95％CI，4.94-8.33]）时，复合结果风险显着（P <.0001）分级增加。 1 <LV WMSI <1的死亡风险比（危险比2.45 [95％CI，1.62-3.71]和8.99 [95％CI，6.3-12.82]）。分别为5和LV WMSI> 1.5。在多变量分析中，左室WMSI和左心房容积指数仍是独立的预测指标。结论锥虫杀灭治疗对5.4年来慢性Chagas心肌病的超声心动图进展无影响。尽管总体左心室收缩功能正常，但局部室壁运动异常和左心房容积指数仍可确定患者发生硬性不良临床预后的风险较高。