Prognostic Value of Natriuretic Peptides in Chagas’ Disease: A 3-Year Follow-Up Investigation

Maria da Consolação Vieira Moreira; Silvia Heringer‐Walther; Niels Wessel; Tiago Moreira Ventura; Yong Wang; Heinz‐Peter Schultheiß; Thomas Walther

doi:10.1159/000112403

December 12, 2007Cardiology

Prognostic Value of Natriuretic Peptides in Chagas’ Disease: A 3-Year Follow-Up Investigation

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Why the study?

Do natriuretic peptide levels predict death or need for heart transplant in patients with Chagas' disease?

Structured PICO

Do natriuretic peptide levels predict death or need for heart transplant in patients with Chagas' disease?

P

Population

216 subjects total: 111 patients with Chagas' disease, 62 patients with dilated cardiomyopathy due to other causes, and 43 gender- and age-matched healthy subjects.

I

Intervention

Measurement of atrial (ANP) and brain natriuretic peptide (BNP) levels.

C

Comparator

Patients with dilated cardiomyopathy due to other causes and healthy subjects.

O

Outcome

Death or necessity for heart transplant.hard clinical

Natriuretic peptides (ANP and BNP) are elevated in early, asymptomatic Chagas' disease and strongly predict death or the need for heart transplantation over a 3-year follow-up.

Implication

May aid prognostication in Chagas disease; hypothesis-generating and requires prospective validation before practice change.

Abstract

BACKGROUND: Chagas' disease (CD) affects around 18 million people in Latin America. To determine the diagnostic and prognostic value of natriuretic peptides in patients with CD, we measured atrial (ANP) and brain natriuretic peptide (BNP), and compared the findings with other dilated cardiomyopathies (DCM). METHODS: Blood samples were obtained from 111 CD patients, 62 patients with DCM due to other causes, and 43 gender- and age-matched healthy subjects. The CD and DCM patients were subdivided according to their NYHA classification. Natriuretic peptide concentrations were determined by immunoradiometric assays. RESULTS: ANP and more pronounced BNP levels were increased in CD and DCM patients in relation to the NYHA class. Circulating BNP concentrations were higher in CD patients in NYHA classes I-II than in the corresponding DCM patients (p = 0.020). Importantly, ANP and BNP were already significantly elevated in CD patients without systolic ventricular dysfunction (p < or = 0.001). In CD patients, both peptides were highly correlated with echocardiographic parameters (p < 10(-14)). Both ANP and BNP had comparable ability to predict death or the necessity for heart transplant (p < 0.0001). CONCLUSION: Natriuretic peptide levels can be used as a marker of asymptomatic CD without ventricular dysfunction and thus could be an ideal tool to identify these patients for early therapy.