[Beneficial effects of enalapril on the diastolic ventricular function in Chagas myocardiopathy]

Abstract

Purpose: To verify the effect of enalapril on ventricular function and on the incidence of ventricular arrhythmias in patients with Chagas' disease with congestive heart failure.

Methods: We studied 20 patients with Chagas' disease, aged between 24 to 64 (mean 44) years. There were 17 male. All patients have positive serologic blood tests for Chagas' disease (immunofluorescence and Machado-Guerreiro test), left ventricular diastolic diameter superior to 55mm and ejection fraction less than 0.60. The patients were divided aleatory in two groups: control group (CG) with 9 patients receiving conventional treatment (digital and diuretics) and enalapril group (EG), with 11 patients where enalapril was added to conventional treatment. The treatment was maintained during two months and the patients were evaluated at the beginning and at the end, when they were submitted to clinical examination, echo-doppler-cardiogram, stress test and 24h Holter monitoring. At two dimensional echocardiographic study we evaluate left ventricular and left atrial diameters, at doppler study the E/A relations, the systolic volume and cardiac index. At the stress test and Holter monitoring we evaluate the incidence of ventricular arrhythmias.

Results: The comparison between initial and final evaluations, showed that there was a significant improvement of diastolic function (p = 0.04) and a trend to improvement of systolic function (great systolic volume and cardiac index) at EG. The incidence of non sustained ventricular tachycardia was the same in the two groups.

Conclusion: In Chagas' disease enalapril improves significantly diastolic dysfunction in patients with heart failure. After two months of treatment we observed tendency to improvement of systolic dysfunction and the incidence of arrhythmias induced by stress test.