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PROGNOSTIC VALUE OF SOLUBLE TNF RECEPTORS IN CHAGAS CARDIOMYOPATHY: OBSERVATIONAL STUDY
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Background: Chronic Chagas cardiomyopathy (CCC) is the most severe clinical form of the Chagas disease. There is a strong correlation between soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2) and cardiac and functional parameters in CCC, but their prognostic value remains unknown. Objective: To verify the prognostic value of sTNFR1 and sTNFR2 in CCC. Methods: A longitudinal study was conducted. Sixty-nine patients with CCC (53.70 ± 9.66 years, NYHA I-II) were submitted to blood collection and echocardiography, and followed for 43.81 ± 1.21 months. The outcome was determined by the combination of cardiac death, heart transplantation, or stroke. Findings: After the follow-up, 15 patients (22%) presented adverse cardiovascular events. Only left ventricular ejection fraction (LVEF) [heart rate at rest (HR): 0.935, 95% CI 0.878 to 0.994; p = 0.033] and sTNFR2 (HR: 1.002, 95% CI 1.001 to 1.003; p = 0.006) remained as independent predictors of adverse cardiovascular events. The optimal cutoff point to identify these patients was the value of 1784.00 pg/mL. There was a significant difference between the groups with lower and higher sTNFR2 levels (long-rank < 0.001). Main Conclusions: High serum levels of sTNFR2, together with lower LVEF, are strong independent predictors of adverse cardiovascular events in CCC, making them valuable for risk stratification.
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