Clinical, electrocardiographic and echocardiographic evolution of chronic Chagas disease treated with nifurtimox on prolonged follow‐up in Chile: observational study

• Published in: Journal of global antimicrobial resistance. 2021-12, Vol.27, p.160-166
• Main Authors: Apt, Werner, Llancaqueo, Marcelo, Zulantay, Inés, Canals, Mauricio, Kara, Sergio, Arribada, Arturo, Muñoz, Gabriela, Martínez, Gabriela
• Format: Article
• Language: English
• Subjects: Cardiomyopathy; Chagas Cardiomyopathy - diagnostic imaging; Chagas Cardiomyopathy - drug therapy; Chagas Disease - drug therapy; Chile; Chronic Chagas disease; Echocardiogram; Echocardiography; Electrocardiogram; Electrocardiography; Follow-Up Studies; Humans; Nifurtimox; Nifurtimox - therapeutic use
• ISSN: 2213-7165; 2213-7173
• DOI: 10.1016/j.jgar.2021.08.012

•Nifurtimox (NFX) treatment shows less progression to cardiomyopathy in chronic Chagas disease.•The final point of prolonged follow-up probed NFX efficacy.•Echocardiogram and electrocardiogram are useful to study the evolution of chronic Chagas disease with treatment. This study aimed to describe the electrocardiographic and echocardiographic status of chronic Chagas disease (cChD) patients treated with nifurtimox. An observational study was performed in 146 cChD patients followed over a mean of 7.9 years. Of the 146 patients, 41 (28.1%) with normal electrocardiogram (ECG) at baseline maintained this condition, 34 (23.3%) with altered ECG at baseline normalised the alterations, and 46 (31.5%) with ECG abnormalities at baseline maintained this condition [23 (15.8%) with small alterations]. Finally, 25 cases (17.1%) in indeterminate phase altered the ECG. Differences before and after follow-up (P < 0.001) were found. The percentage of beneficial treatment was different than expected by chance (Z = 4.8; P < 0.001) and the annual percentage of cases that developed ECG alterations was lower than that of a historical cohort of untreated patients (P < 0.001). An echocardiogram was performed in 68 patients with baseline ECG alterations. The ejection fraction (EF) was normal in 57 (83.8%) and abnormal in 11 (16.2%). In 38 patients with ECG abnormalities that did not progress after treatment, EF and segmental motility (SM) were normal in 31 (81.6%) and 26 (68.4%), respectively. In 17 patients with ECG abnormalities, EF and SM were normal in 15 (88.2%) and 14 (82.4%) cases, respectively. Less progression to cardiomyopathy compared with a historical untreated cohort as well as the EF/SM results in patients with abnormal ECG that did not progress and in indeterminate cChD that altered the ECG suggests a beneficial effect of nifurtimox.