Biomakers in Chronic Chagas Cardiomyopathy

Abstract

The primary objective was to observe the relationship between serum levels of BNP, Ca-125, C-reactive protein and uric acid as prognostic and functional markers in patients with chronic Chagas cardiomyopathy (CCC). Circulating levels of cytokines: IL-1β, TNFα, IL-10, IL6, IL-8 and IL-12 were determined and investigated regarding their association with hemodynamic parameters, clinical signs of heart failure and outcome. Chagas is still a neglected disease that affects numerous individuals, many of them in their most productive years. CCC with left ventricular dysfunction is the most severe presentation of Chagas Disease. BNP is a well-recognized prognostic and clinical biomarker, not only in chronic heart failure patients but also in patients with CCC. Previous studies have shown Ca-125, C-reactive protein, and uric acid to be potentially good prognostic markers in heart failure (HF). Fifty patients with left ventricular fraction less (LVEF) than 55% were selected and followed for a mean period of 18 ± 8.3 months. Patient's mean age was 43.42 ± 10.3 years (32 male), their BNP was 293 (160-530) pg/mL, Ca-125 8.5 (5.5-16.75) U/mL, uric acid 6.2 ± 2 mg/dL, and C- reactive protein 4.5 (4.5-7.3) mg/L. Patients who had LVEF less than 35% had higher BNP (p = 0.0023), Ca-125 (p = 0.027) and uric acid (p = 0.01) serum levels. Patients who died also showed higher BNP (p = 0.01), uric acid (p = 0.05) and a trend towards higher Ca-125 serum levels (p = 0.056). All markers: BNP, Ca-125, uric acid and C-reactive had good predictability of death in Cox-regression univariate analysis, however, not on the final multivariate model. Of the inflammatory cytokines, IL-8 and IL-12 showed a relation to LVEF of less than 35%. IL-12 was related to adverse cardiovascular events and non-survival. IL-1β was a good predictor of mortality in the final Cox regression model. Determination of Ca-125, uric acid levels and C-reactive protein may add useful clinical and prognostic information and may help clinical decision making for patients with CCC.

Keywords: Chagas cardiomyopathy; biomakers; cytokines.

Figure 1

(A) BNP, Ca-125, uric acid, C-reactive protein serum levels and LVEF. (B) LVEF (patients grouped according to LVEF <35% or >35%) and BNP (bars represent median and 25th and 75th percentiles of circulating levels). (C) LVEF (patients grouped according to LVEF <35% or >35%) and Ca-125 (bars represent median and 25th and 75th percentiles of circulating levels). LVEF (patients grouped according to LVEF <35% or >35%) and uric acid (bars represent median and 25th and 75th percentiles of circulating levels). (D) LVEF (patients grouped according to LVEF <35% or >35%) and C-reactive protein (bars represent median and 25th and 75th percentiles of circulating levels). *, refers to group outliners; °, refers to group ouliners.

Figure 2

BNP, Ca-125, uric acid, C-reactive protein serum levels and RV dilation. (A) RV dilation (presence on echocardiogram) and BNP (bars represent median and 25th and 75th percentiles of circulating levels). (B) RV dilation (presence on echocardiogram) and Ca-125 (bars represent median and 25th and 75th percentiles of circulating levels). (C) RV dilation (presence on echocardiogram) and uric acid (bars represent median and 25th and 75th percentiles of circulating levels). (D) RV dilation (presence on echocardiogram) and C-reactive protein (bars represent median and 25th and 75th percentiles of circulating levels). *, group outliers; ° group outliers.