efeitos da inibição do sistema renina-angiotensina-aldosterona e do ...

Apêndice C
Artigos Elaborados a partir da tese
Artigo 1
Publicado no American Heart Jourrnal (Am Heart J. 2007;153:544.e1-544.e8).
Resumo apresentado no Congresso Mundial de Cardiologia – Barcelona 2006, e no
Congresso Brasileiro de Cardiologia – Recife 2006-11-04.
Premiado como melhor trabalho da Reunião de Pesquisa em Doença de Chagas e
Leishmanioses – Uberaba 2006
A Randomized Trial of Carvedilol after Renin-Angiotensin System
Authors:
Inhibition in Chronic Chagas Cardiomyopathy
FA. Botoni 1 , PA. Poole-Wilson 2 , AL. Ribeiro 1 , DO. Okonko 2 , BMR. Oliveira 1 , MM. Teixeira 1 ,
AM. Reis 1 , MOC. Rocha 1 - (1) Federal University of Minas Gerais, Belo Horizonte, Brazil (2)
National Heart and Lung Institute, London - Uk, United Kingdom
Background: chronic Chagas cardiomyopathy (CCC) causes substantial morbidity and mortality in
Latin America. Whether RAS inhibition and β-blockers are safe and beneficial has been challenged
because of the lack of formal trials.
Methods: we conducted a double-blind, placebo-controlled randomised trial in 42 patients with
Trypanosoma cruzi infection and cardiomyopathy. All patients received enalapril, uptitrated to
20mg bid, and spironolactone 25mg od. Subsequently, 20 patients were randomly assigned to
placebo and 19 to carvedilol up-titrated to 25mg bid. The primary endpoint was change in LVEF
after RAS inhibition and after addition of carvedilol. Secondary endpoints were change in other
echo parameters, Framingham score (FSc), quality of life (SF36), NYHA class, radiographic
indices, BNP, chemokines and safety endpoints.
Results: optimisation of RAS inhibition was safe, hemodynamically well-tolerated, and associated
with improvements in FSc (p=0.001), quality of life, and reductions in the cardiothoracic index
(p=0.002), BNP (p=0.032) and RANTES (p=0.001). LVEF increased by 2.3% (p=0.25); in patients
with LVEF≤45% the increase was 2.8% (p=0.017). Treatment with carvedilol was associated with
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