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Canadian Journal of Cardiology

β1-Selective Adrenoceptor Antagonists Increase Plasma Levels of Anti-p2β Antibodies and Decrease Cardiac Involvement in Chronic Progressive Chagas Heart Disease

Published:December 26, 2013DOI:https://doi.org/10.1016/j.cjca.2013.09.017

      Abstract

      Background

      Studies indicate that antibodies cross-reacting with cardiac β1 adrenergic receptors are likely to play a role in the development of chronic Chagas heart disease (CCHD). In parallel, clinical trials have shown that β1 antagonist drugs exert beneficial effects in the prognosis of patients with CCHD. In a group of patients with CCHD undergoing therapy with β1-blockers, we have now evaluated the levels of anti-p2β antibodies and the severity of CCHD.

      Methods

      We performed a cross-sectional study in Trypanosoma cruzi seropositive patients categorized according to a standard CCHD classification. All individuals were subjected to a complete clinical examination.

      Results

      There was no association between CCHD stages, electrocardiographic conduction disturbances, and echocardiogram pathological signs with the levels of autoantibodies. However, when patients were analyzed according to selective cardio-β1-blocker therapy, those receiving treatment had higher levels of anti-p2β. Patients from CCHD stage III treated with combined therapy of cardio-β1-selective blockers, enalapril, and statins, presented decreased cardiac involvement and lower score of risk of mortality than individuals from the same group who were not treated.

      Conclusions

      Our results suggest that selective cardio-β1-blockers might modify the autoantibody anti-p2β levels, and that combined therapy in patients with stage III CCHD might be associated with lower cardiac involvement and risk score of mortality in patients with heart failure. Longitudinal studies will help to ascertain the proper role of β1-blockers in the immunopathological processes underlying chronic Chagas disease.

      Résumé

      Introduction

      Les études indiquent que les anticorps ayant une réaction croisée avec les récepteurs β1-adrénergiques cardiaques sont susceptibles de jouer un rôle dans le développement de la cardiopathie chagasique chronique (CCC). Parallèlement, les essais cliniques ont montré que les antagonistes β1 exercent des effets bénéfiques dans le pronostic des patients ayant une CCC. Dans un groupe de patients ayant une CCC subissant le traitement par des β1-bloquants, nous avons maintenant évalué les concentrations d'anticorps anti-p2β et la gravité de la CCC.

      Méthodes

      Nous avons réalisé une étude transversale chez des patients séropositifs pour le Trypanosoma cruzi répartis selon une classification standard de la CCC. Tous les individus étaient sujets à un examen clinique complet.

      Résultats

      Il n'y avait aucune association entre les stades de la CCC, les perturbations de la conduction électrocardiographique et les signes pathologiques à l'échocardiogramme quant aux concentrations d'autoanticorps. Cependant, lorsque les patients étaient analysés selon le traitement par β1-bloquants cardiosélectifs, ceux recevant le traitement avaient des concentrations plus élevées d'anti-p2β. Les patients ayant une CCC de stade III, qui reçoivent le traitement combiné de β1-bloquants cardiosélectifs, d'énalapril et de statines, montraient une diminution de l'implication cardiaque et un plus faible score de risque de mortalité que les individus du même groupe qui n'étaient pas traités.

      Conclusions

      Nos résultats suggèrent que les β1-bloquants cardiosélectifs pourraient modifier les concentrations d'anticorps anti-p2β et que le traitement combiné chez les patients ayant une CCC de stade III pourrait être associé à une implication cardiaque et un score de risque de mortalité plus faibles chez les patients ayant une insuffisance cardiaque. Des études longitudinales aideront à établir le rôle propre des β1-bloquants dans les processus immunopathologiques de la maladie de Chagas chronique sous-jacente.
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