Abstract:

Introduction and objectives Trypanosoma cruzi infection has been shown to induce humoral autoimmune responses against host antigens tissues. Particularly, antibodies cross-reacting with myocardial antigens may play a role in the development of the severe forms of chronic Chagas disease. The aim of this study was to determine the association between clinical stage of the disease and the presence of autoantibodies in patients with chronic Chagasic disease. Methods We performed a cross-sectional study in T. cruzi-seropositive patients divided into 3 groups according to the classic classification of chronic Chagas heart of Storino et al. All participants underwent complete clinical examination and their sera were used to measure autoantibody levels. Results All patients had detectable levels of anti-p2β and anti-B13 autoantibodies but none had anti-Na-K-ATPase antibodies. No association was observed between electrocardiographic conduction disturbances and autoantibody levels. Patients with chronic Chagas disease stage III had the highest levels of anti-B13 antibodies and a high risk of mortality score, showing a clear association between disease stage and this score. Conclusions Anti-B13 antibodies were significantly higher in chronic Chagas disease stage III patients, suggesting that these antibodies may be involved in disease progression and that they might be a useful marker of poor prognosis in terms of heart compromise. Our results also reveal an important correlation between the level of anti-B13 autoantibodies and symptomatic heart failure and/or dilated cardiomyopathy.

Introducción y objetivos La infección por Trypanosoma cruzi induce una respuesta autoinmunitaria humoral contra diferentes antígenos del huésped. En especial, los anticuerpos que presentan reactividad cruzada con antígenos del miocardio tienen un papel importante en el desarrollo de las formas graves de la cardiopatía chagásica crónica. En este trabajo se analiza la asociación del estadio clínico de la enfermedad con la presencia de autoanticuerpos en pacientes con cardiopatía chagásica crónica. Métodos Estudio transversal con pacientes con serología positiva para enfermedad de Chagas, categorizados en tres grupos según la clasificación de cardiopatía chagásica de Storino et al. Se realizó a todas las personas incluidas un examen clínico completo y se usaron las muestras de suero para cuantificar los autoanticuerpos. Resultados Todos los pacientes presentaron cantidades detectables de anti-p2β y anti B13; el anti-Na-K-ATPasa fue negativo en todos los casos. No se halló asociación significativa entre las alteraciones electrocardiográficas y los valores de autoanticuerpos. Los pacientes con cardiopatía chagásica en estadio III presentaron mayor concentración de anti-B13 y riesgo de mortalidad alto, lo que muestra una clara asociación entre el estadio de la enfermedad y la puntuación de mortalidad. Conclusiones La concentración del autoanticuerpo anti-B13 fue significativamente mayor en los pacientes con cardiopatía chagásica en estadio III, lo que indica que este anticuerpo puede estar involucrado en la progresión de la enfermedad y podría usarse como marcador de mal pronóstico respecto a la afección cardiaca. Los resultados revelan también una importante correlación entre el anti-B13 y la insuficiencia cardiaca sintomática y/o la cardiomiopatía dilatada.

Author affiliation: Vicco, Miguel H. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas, Santa Fe; Argentina

Abstract:

The effectiveness of intra-aortic balloon pumping (IABP) is currently evaluated using indirect indexes. The diastolic pressure augmentation is quantified using the subendocardial viability ratio (SEVR) and the DABAC/SABAC index (areas beneath the aortic pressure–time signals during the diastolic and systolic periods, respectively). The SEVR requires invasive recordings of left ventricular pressure; the DABAC/SABAC index may represent an alternative, since it only requires an aortic pressure signal. Nonetheless, it has never been used in an animal model of counterpulsated heart failure and ischemia-reperfusion episode. The aims of this work were: (i) to develop an animal model of heart failure, with a myocardial ischemia-reperfusion episode, treated with IABP during the reperfusion period; (ii) to evaluate the effects of the IABP using the SEVR and DABAC/SABAC indices; and (iii) to assess the relationship between both ratios. Cardiovascular parameters were obtained in anesthetized sheep, in which induced heart failure and ischemia-reperfusion episodes were monitored with and without IABP 1:2. Systolic and diastolic blood pressure signals were assessed in the aorta and in the left ventricle. Values of cardiac output and left ventricular wall thickness signals were obtained. Induction of ischemia and heart failure determined decreases in SEVR and DABAC/SABAC indices with respect to their basal stage (0.807 ± 0.118 vs. 0.601 ± 0.107, P < 0.05 and 1.062 ± 0.136 vs. 0.902 ± 0.161, P < 0.05, respectively). Counterpulsated animals whose myocardial reperfusion was accompanied by heart failure showed a significant improvement of wall thickening fraction along time (R 2  = 0.7627, P < 0.001). During counterpulsated heart failure accompanied by myocardial reperfusion, the SEVR was positively correlated with DABAC/SABAC index.

Author affiliation: Wray, Sandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina

Author affiliation: Lascano, Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina

Author affiliation: Negroni, Jorge Antonio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina

Author affiliation: Cabrera Fischer, Edmundo Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina

Abstract:

Objective To explore the relationship between ventricular filling curves and the extent of late enhancement on cardiac magnetic resonance imaging (MRI) in patients with hypertrophic cardiomyopathy. Material and methods We retrospectively included consecutive patients with suspected and/or confirmed hypertrophic cardiomyopathy and a control group of patients matched for age and sex who underwent cardiac MRI with evaluation of late enhancement. Among other determinations, we evaluated the following parameters on cine sequences: peak filling rate, time to the first peak filling rate, and filling rate normalized to the filling volume. Results Late enhancement was observed in 29 (73%) of the 40 patients with hypertrophic cardiomyopathy. The normalized peak filling rate was significantly lower in patients with late enhancement (4.9  ±  1.6 in those with hypertrophic cardiomyopathy positive for late enhancement vs. 5.8  ±  2.2 in those with hypertrophic cardiomyopathy negative for late enhancement vs. 6.3  ±  1.5 in controls, p  =  0.008) and the time to peak filling was longer in patients with late enhancement (540.6  ±  89.7 ms vs. 505.5  ±  99.3 ms in those with hypertrophic cardiomyopathy negative for late enhancement vs. 486.9  ±  86.3 ms in controls, p  =  0.02). When the population was stratified into three groups in function of the normalized peak filling rate, significant differences were observed among groups for age (p  =  0.002), mean wall thickness (p  =  0.036), and myocardial mass (p  =  0.046) and atrial dimensions, whereas no significant differences with respect to late enhancement were seen. Conclusions In patients with hypertrophic cardiomyopathy, we found a significant association between ventricular filling patterns and age, wall thicknesses, and atrial dimensions, but not with the extent of late enhancement.

Objetivo Explorar mediante resonancia magnética cardíaca la relación entre las curvas de llenado ventricular y la extensión del realce tardío (RT) en pacientes con miocardiopatía hipertrófica. Material y métodos Se incluyeron de forma retrospectiva pacientes consecutivos con sospecha y/o diagnóstico de miocardiopatía hipertrófica, y un grupo control de pacientes pareados según sexo y edad en quienes se realizó una resonancia magnética cardíaca con valoración de RT. Entre otras determinaciones, se evaluaron mediante secuencias cine: tasa de llenado pico, tiempo a la primera tasa de llenado pico y tasa de llenado pico normalizada al volumen de llenado. Resultados De los 40 pacientes con miocardiopatía hipertrófica, 29 (73%) presentaron RT. Se evidenciaron diferencias significativas respecto a la tasa de llenado pico normalizada (RT positivo 4,9 ± 1,6, vs. RT negativo 5,8 ± 2,2, vs. control 6,3 ± 1,5, p = 0,008) y al tiempo a la tasa de llenado pico (540,6 ± 89,7 ms, vs. 505,5 ± 99,3 ms, vs. 486,9 ± 86,3 ms, p = 0,02). Al estratificar la población en tercios según la tasa de llenado pico normalizada al volumen de llenado se registraron diferencias significativas entre los grupos respecto a la edad (p = 0,002), espesor parietal medio (p = 0,036), masa miocárdica (p = 0,046) y dimensiones auriculares, mientras que no se observaron diferencias significativas respecto al RT. Conclusiones En pacientes con miocardiopatía hipertrófica encontramos una asociación significativa entre patrones de llenado ventricular y edad, espesores parietales y dimensiones auriculares, mientras que no se identificó una relación significativa con la extensión del RT.

Author affiliation: De Zan, M.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina

Author affiliation: Carrascosa, P.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina

Author affiliation: Deviggiano, A.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina

Author affiliation: Capunay, C.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina

Author affiliation: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina

Abstract:

1. This study investigates the time course of pulmonary arterial hypertension (PAH) due to monocrotaline (MCT) and its association with cardiac function and oxidative stress markers in the left ventricle (LV). 2. Male Wistar rats were divided into six groups: 7days, 21days, and 31days for both control and MCT groups. Following echocardiographic analysis, the heart was removed. The LV was separated and homogenized to analyze oxidized-to-total glutathione ratio and thioredoxin reductase (TrxR) activity as well as hydrogen peroxide (H 2O 2) and ascorbic acid levels. 3. There was significant (P<0.01) cardiac and right ventricle (RV) hypertrophy and pulmonary congestion in the MCT 21day and 31day groups. Echocardiography showed a change in the flow wave of the pulmonary artery at 21days after MCT treatment. There was an increase in the LV ejection time (P<0.05) at 31days after MCT. The LV H 2O 2 concentration was increased (P<0.05) in the MCT 21day and MCT 31day groups compared with controls. There was a reduction (P<0.05) in the LV ascorbic acid concentration and an increase (P<0.05) in TrxR activity in the MCT 31day rats. 4. Our findings showed RV changes due to pulmonary hypertension at 21days after MCT injection. There was a correlation between the degree of dysfunction and the morphometry of the heart chambers, along with impairment of the antioxidant/pro-oxidant balance in the LV 31days after the beginning of the protocol. This study suggests that LV changes follow RV dysfunction subsequent to pulmonary hypertension.

Author affiliation: Leichsenring Silva, Fabiano. Universidade Federal do Rio Grande do Sul; Brasil

Author affiliation: Tavares, Angela Maria Vicente. Universidade Federal do Rio Grande do Sul; Brasil

Author affiliation: Mosele, Francisca. Universidade Federal do Rio Grande do Sul; Brasil

Author affiliation: Berger, Bruno. Universidade Federal do Rio Grande do Sul; Brasil

Author affiliation: Llesuy, Susana Francisca. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Bioquímica y Medicina Molecular. Universidad de Buenos Aires. Facultad Medicina. Instituto de Bioquímica y Medicina Molecular; Argentina

Author affiliation: Belló Klein, Adriane. Universidade Federal do Rio Grande do Sul; Brasil

Abstract:

AIMS: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes. METHODS AND RESULTS: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate < 60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106-117) g/L. CONCLUSION: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.

Author affiliation: McMurray, John J. V.. University of Glasgow; Reino Unido

Author affiliation: Anand, Inder S.. University of Minnesota; Estados Unidos

Author affiliation: Diaz, Rafael. Estudios Clínicos Latinoamérica; Argentina

Author affiliation: Maggioni, Aldo P.. Associazione Nazionale Medici Cardiologi Ospedalieri; Italia

Author affiliation: O'Connor, Christopher. University of Duke; Estados Unidos

Author affiliation: Pfeffer, Marc A.. Brigham and Women’s Hospita; Estados Unidos

Author affiliation: Solomon, Scott D.. Brigham and Women’s Hospital; Estados Unidos

Author affiliation: Tendera, Micha. Medical University of Silesia; Polonia

Author affiliation: van Veldhuisen, Dirk J.. University of Groningen; Países Bajos

Author affiliation: Moetaz, Albizem. Amgen Inc.; Estados Unidos

Author affiliation: Cheng, Sunfa. Amgen Inc.; Estados Unidos

Author affiliation: Scarlata, Debra. Amgen Inc.; Estados Unidos

Author affiliation: Swedberg, Karl. University of Gothenburg; Suecia

Author affiliation: Young, James B.. Cleveland Clinic. Endocrinology and Metabolism Institute; Estados Unidos

Author affiliation: Toblli, Jorge Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Author affiliation: RED-HF Committees Investigators.

Abstract:

Background Two potent carbonic anhydrase (CA) inhibitors with widely differing membrane permeability, poorly diffusible benzolamide (BZ), and highly diffusible ethoxzolamide (ETZ) were assessed to determine whether they can reduce cardiac dysfunction in rats subjected to coronary artery ligation (CAL)-induced myocardial infarction. Methods and results Rats with evidence of heart failure (HF) at 32 weeks following a permanent left anterior coronary artery occlusion were treated with placebo, BZ, or ETZ (4 mg kg�day−1) for 4 weeks at which time left ventricular function and structure were evaluated. Lung weight/body weight (LW/BW) ratio increased in CAL rats by 17�1% vs. control, suggesting pulmonary edema. There was a trend for BZ and ETZ to ameliorate the increase in LW/BW by almost 50% (9�5% and 9�8%, respectively, versus CAL) (P=.16, NS). Echocardiographic assessment showed decreased left ventricular midwall shortening in HF rats, 21�1% vs. control 32�1%, which was improved by BZ to 29�1% and ETZ to 27�1%, and reduced endocardial shortening in HF rats 38�3% vs. control 62�1%, partially restored by BZ and ETZ to ~50%. Expression of the hypoxia-inducible membrane-associated CAIX isoform increased by ~60% in HF rat hearts, and this effect was blocked by ETZ. Conclusions We conclude that CAL-induced myocardial interstitial fibrosis and associated decline in left ventricular function were diminished with BZ or ETZ treatment. The reductions in cardiac remodeling in HF with both ETZ and BZ CA inhibitors suggest that inhibition of a membrane-bound CA appears to be the critical site for this protection.

Author affiliation: Vargas, Lorena Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Investigaciones Cardiovasculares ; Argentina

Author affiliation: Pinilla, Oscar Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Investigaciones Cardiovasculares ; Argentina

Author affiliation: Diaz, Romina Gisel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Investigaciones Cardiovasculares ; Argentina

Author affiliation: Sepúlveda, Diana Elizabeth. Universidad Favaloro. Facultad de Medicina. Departamento de Ciencias Básicas de la Patología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Author affiliation: Swenson, Erik R.. University of Washington. School of Medicine; Estados Unidos

Author affiliation: Perez, Nestor Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Investigaciones Cardiovasculares ; Argentina

Author affiliation: Alvarez, Bernardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Investigaciones Cardiovasculares ; Argentina

Abstract:

Introducción y objetivos La insuficiencia cardiaca es un grave problema de salud pública. El objetivo de la revisión es estimar la carga de insuficiencia cardiaca en Latinoamérica. Métodos Revisión sistemática y metanálisis, tras búsqueda en MEDLINE, EMBASE, LILACS y CENTRAL desde enero de 1994 a junio de 2014, sin restricción de idioma. Se incluyeron estudios experimentales y observacionales con al menos 50 participantes de edad ≥ 18 años. Resultados Se incluyeron 143 de las 4.792 referencias recuperadas. La mayoría de los estudios se realizaron en Sudamérica (92%), principalmente en Brasil (64%). La media de edad era 60 ± 9 años y la fracción de eyección media, del 36 ± 9%. La incidencia de insuficiencia cardiaca en el único estudio poblacional identificado fue de 199/100.000 personas-años; la prevalencia, del 1% (intervalo de confianza del 95% [IC95%], 0,1-2,7%); las tasas de rehospitalización, del 33, el 28, el 31 y el 35% a 3, 6, 12 y 24-60 meses de seguimiento respectivamente, y la mediana de estancia hospitalaria, 7,0 días. La tasa de mortalidad al año fue del 24,5% (IC95%, 19,4-30,0%). La mortalidad intrahospitalaria fue del 11,7% (IC95%, 10,4-13,0%), y aumentaba en pacientes con fracción de eyección reducida, cardiopatía isquémica y enfermedad de Chagas. Conclusiones Pocos estudios han evaluado la incidencia y la prevalencia de insuficiencia cardiaca en Latinoamérica. Se hallaron altas tasas de mortalidad y de hospitalización, y la heterogeneidad es su principal limitación. Este estudio brinda la información epidemiológica disponible para la toma de decisiones sobre esta enfermedad. Se requieren más estudios con metodologías estandarizadas y en poblaciones representativas.

Introduction and objectives Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. Methods Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. Results In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100 000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. Conclusions Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line.

Author affiliation: Ciapponi, Agustín. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Author affiliation: Alcaraz, Andrea. Instituto de Efectividad Clínica y Sanitaria; Argentina

Author affiliation: Calderon, María. Instituto de Efectividad Clínica y Sanitaria; Argentina

Author affiliation: Matta, María Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina

Author affiliation: Chaparro, Martin. Instituto de Efectividad Clínica y Sanitaria; Argentina

Author affiliation: Soto, Natalie. Instituto de Efectividad Clínica y Sanitaria; Argentina

Author affiliation: Bardach, Ariel Esteban. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Abstract:

BACKGROUND: Treatment of iron deficiency helps to improve cardiac and renal function in patients with chronic heart failure. However, the mechanism by which this occurs is currently unclear. METHODS: We undertook a double-blind, randomised, placebo-controlled study of intravenous iron sucrose treatment (200mg/mL weekly for five weeks) in patients with chronic heart failure, chronic kidney disease and iron-deficiency anaemia receiving optimal treatment for chronic heart failure (N=60). Markers of disease severity, iron status, anaemia and inflammation were measured during a six-month follow-up period, and evaluation of echocardiographic parameters was performed at baseline and six months after treatment. RESULTS: At six months after treatment initiation, intravenous iron was associated with reduced severity of the symptoms of chronic heart failure and improved renal function (both p<0.001 versus control). Also, ferritin and transferrin saturation levels were increased, as were haemoglobin levels, whereas inflammatory markers were reduced (all p<0.001 versus control). Left ventricular systolic and diastolic diameters were increased and improved left ventricular function correlated with iron status in patients receiving intravenous iron but not patients in the control group. CONCLUSIONS: Intravenous iron treatment was associated with improved myocardial functional parameters and cardiac dimensions in patients with anaemia and chronic kidney disease.

Author affiliation: Toblli, Jorge Eduardo. Hospital Alemán; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Author affiliation: DiGennaro, Federico. Hospital Alemán; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentina

Author affiliation: Rivas, Carlos Francisco. Hospital Alemán; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentina

Abstract:

Objective: Autoantibodies cross-reacting with the β1 adrenergic receptor (anti-β1AR and anti-p2β) and cardiac myosin antigens (anti-B13) have been related to the pathogenesis of chronic Chagas heart disease (CCHD). Studies exploring their levels in different stages are scarce. We aimed to evaluate the relationship of these autoantibodies with the clinical profile of chronic patients, especially regarding their classificatory accuracy in severe presentation with heart failure. Methods and results: We conducted a cross-sectional study of 155 T. cruzi-seropositive patients and 26 age- and gender-matched healthy controls. They were categorised in three stages of CCHD. Serum antibodies were measured by specific immunoassays. Symptomatic individuals showed increased levels of anti-β1AR and anti-B13, while anti-p2β antibodies were similar between groups. A composite logistic regression model including anti-B13, anti-β1AR antibody levels and age was able to predict systolic heart failure yielding an area under the curve of 83% (sensitivity of 67% and specificity of 89%). Conclusions: In our study, anti-β1AR and anti-B13 antibodies were higher in individuals with chronic Chagas heart disease stage III, mainly in those with dilated cardiomyopathy associated with systolic heart failure. Logistic regression analysis showed that both antibodies were good predictors of severe CCHD. As well as being involved in disease progression, anti-β1AR and anti-B13 antibodies may be used as a serum marker of poor prognosis in terms of heart compromise.

Author affiliation: Rodeles Antonelli, Luz María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral; Argentina

Author affiliation: Vicco, Miguel Hernán. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral; Argentina

Author affiliation: Bontempi, Iván. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral; Argentina

Author affiliation: Siano, Alvaro Sebastían. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral; Argentina

Author affiliation: Tonarelli, Georgina Guadalupe. Universidad Nacional del Litoral; Argentina

Author affiliation: Bottasso, Oscar Adelmo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario; Argentina

Author affiliation: Arias, Pablo. Universidad Nacional de Rosario; Argentina

Author affiliation: Marcipar, Iván Sergio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral; Argentina

Abstract:

Studies indicate that Trypanosoma cruzi is capable of inducing immunological disturbances such as decreased expression of molecules involved in T-cell survival and costimulation for antigen-driven T-cell responses. On the other hand, several reports have described that BCG vaccination induces a T-helper 1-type immune response with protective effects in different pathologies. In this regard, we evaluated whether BCG vaccination coexists with a better clinical and immunological profile of chronic Chagas heart disease (CCHD). We performed a cross-sectional study in T. cruzi seropositive patients categorized according the BCG vaccine background and to the well-established CCHD classification provided by Storino et al. All individuals were subjected to a complete clinical examination. All patients presented detectable levels of autoantibodies anti-p2β, anti-B13, anti-FRA and antiparasite homogenate immunoglobulins, which were unrelated to age and sex distribution or blood pressure values. Comparisons according to BCG vaccination revealed that individuals who had not been vaccinated presented higher values of antibodies, and patients without BCG vaccine had an OR of 6.1 (95 % CI 1.23?29.25, p = 0.02) for globally dilated cardiomyopathy with reduced ejection fraction (Hosmer and Lemeshow test of 5.2 p = 0.73). Our results suggest that BCG vaccination coexists with a better clinical and immunological profile of CCHD, associated with lower cardiac involvement.

Author affiliation: Vicco, Miguel Hernán. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; Argentina. Provincia de Santa Fe. Ministerio de Salud. Hospital J. B. Iturraspe; Argentina

Author affiliation: Bontempi, Iván. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina

Author affiliation: Rodeles, Luz. Provincia de Santa Fe. Ministerio de Salud. Hospital J. B. Iturraspe; Argentina

Author affiliation: Yodice, Agustina. Provincia de Santa Fe. Ministerio de Salud. Hospital J. B. Iturraspe; Argentina

Author affiliation: Marcipar, Iván Sergio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; Argentina

Author affiliation: Bottasso, Oscar Adelmo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Inmunología Clinica y Experimental de Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Instituto de Inmunología Clinica y Experimental de Rosario; Argentina