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European Heart Journal 1992 13(7):966-970;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Chagas cardiomyopathy and captopril

R. R. ROBERT{dagger},*, E. E. MARTINEZ*, J. L. ANDRADE*, V. L. ARAUJO*, F. S. BRITO*, O. P. PORTUGAL* and S. F. HOROWITZ{dagger},

{dagger}Division of Cardiology, Escola Paulista de Medicina Rua Botucatu 611 Sao Paulo, SP, 04023 Brazil
*Division of Cardiology, Beth Israel Medical Center First Ave. at 16th St. New York, 10003 New York, U.S.A.

Received 3 April 1991; revised 1 September 1991; .

Correspondence- Dr Steven F. Horowitz, Beth Israel Medical Center, First Ave at 16th St. 8th Dazian, New York, NY (212)420-45-60, U.S.A.

Abstract

Chagas disease is a leading cause of heart failure in Latin America. Sudden death occurs in approximately 40% of patients with heart failure due to Chagas disease. We report a single blind, cross-over trial of prolonged treatment with captopril and placebo in 18 Chagas disease patients with class IV NYHA heart failure. Ventricular dimensions, neurohormones, electrolytes and ventricular arrhythmias were analysed in 11 men and seven women receiving stable doses ofdigoxin and frusemide who were randomly divided into two intervention groups. Group I patients were given increasing doses of captopril up to 150 mg. day–1 maintained for 6 weeks, group II received the placebo. A 24 h Holier, 2-D echocardiogram, urinary catecholamines, plasma renin and electrolyte determinations were performed at the end of each phase. After a 2-week washout period, the two groups crossed over and another period of 6 weeks was observed. Ventricular arrhythmias were analysed by either Mann-Whitney or the Wilcoxon test. Remaining data were assessed by the Student t-test. A significant reduction in heart rate and urinary catecholamine levels, and enhanced plasma levels ofrenin, together with a reduction in ventricular couplets was found in the captopril-treated group. We conclude that captopril has a beneficial effect on neurohormones with a subsequently reduced heart rate and diminished incidence of ventricular arrhythmias in patients with Chagas disease. This effect might result in a reduction of mortality caused by the disease, suggesting the need for further investigations.

Key Words: Chagas • cardiomyopathy • captopril • arrhythmias


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