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The benefit of de novo cardiac resynchronisation therapy (CRT) implantation in selected patients with heart failure is well known. The number of upgrade procedures is increasing but data on clinica...

Aims This study aimed to analyse the clinical presentation and prognosis of patients with Chagas cardiomyopathy and decompensated heart failure (HF), as compared with other aetiologies. Methods and results A prospective cohort of patients admitted with decompensated HF. We included 767 patients (63.9% male), with median age of 58 years [interquartile range 48.2-66.7 years]. Main aetiologies were non-Chagas/non-ischaemic cardiomyopathies in 389 (50.7%) patients, ischaemic disease in 209 (27.2%), and Chagas disease in 169 (22%). Median left ventricular ejection fraction was 26% (interquartile range 22-35%). Patients with Chagas differed from both patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies for a higher proportion of cardiogenic shock at admission (17.8%, 11.6%, and 11%, respectively, P < 0.001) and had lower blood pressure at admission (systolic blood pressure 90 [80-102.5], 100 [85-110], and 100 [88.2-120] mmHg, P < 0.001) and lower heart rate (heart rate 71 [60-80], 87 [70-102], and 79 [64-96.5] b.p.m., P < 0.001). Further, patients with Chagas had higher serum BNP level (1544 [734-3148], 1061 [465-239], and 927 [369-1455] pg/mL, P < 0.001), higher serum bilirubin (1.4 [0.922.44], 1.2 [0.77-2.19], and 0.84 [0.49-1.45] mg/dL, P < 0.001), larger left ventricular diameter (68 [63-73], 67 [58-74], and 62 [56.8-68.3] mm, respectively, P < 0.001), lower left ventricular ejection fraction (25 [21-30]%, 26 [22-35]%, and 30 [25-38]%, P < 0.001), and a higher proportion of patients with right ventricular function (48.8%, 40.7%, and 25.9%, P < 0.001). Patients with Chagas disease were more likely to receive inotropes than patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies (77.5%, 67.5%, and 62.5%, respectively, P = 0.007) and also to receive intra-aortic balloon pumping (30.8%, 16.2%, and 10.5%, P < 0.001). Overall, the rates of death or urgent transplant were higher among patients with Chagas than in other aetiologies, a difference that was driven mostly due to increased rate of heart transplant during hospital admission (20.2%, 10.3%, and 8.1%). The prognosis of patients at 180 days after hospital admission was worse for patients with Chagas disease as compared with other aetiologies. In patients with Chagas, age [odds ratio (OR) = 0.934, confidence interval (CI)(95%) 0.901-0.982, P = 0.005], right ventricular dysfunction by echocardiography (OR = 2.68, CI95% 1.055-6.81, P = 0.016), and urea (OR = 1.009, CI95% 1.001-1.018, P = 0.038) were significantly associated with prognosis. Conclusions Patients with Chagas cardiomyopathy and decompensated HF have a distinct clinical presentation and worse prognosis compared with other aetiologies.

[Jogani, Siddharth; Schroyens, Matthew; Herbots, Lieven] Jessa Hosp, Heart Ctr Hasselt, Dept Cardiol, Hasselt, Belgium. [Yilmaz, Alaaddin] Jessa Hosp Hasselt, Dept Cardiosurg, Hasselt, Belgium.

Objective and importance: Late postpartum eclampsia is characterized by pre-eclampsia and tonic-clonic seizures presenting more than 48 hours postpartum. It is a rare, frightening and dangerous complication that requires rapid recognition and adequate treatment. Clinical presentation: We present a case of late postpartum eclampsia, initially diagnosed as right-sided heart failure, 10 days postpartum.Two days after the delivery she developed mild swelling of both feet, progressive shortness of breath on exertion and orthopnea. Intervention: Transthoracic echocardiography revealed sever tricuspid regurgitation in combination with pulmonary hypertension. The patient wasadmitted to the intensive care unit (ICU) and a tentative diagnosis of pulmonary hypertension was made. On arrival in the ICU, the patient developed a tonic-clonic seizure and urinalysis revealed proteinuria, indicating eclampsia. Treatment of eclampsia was initiated with complete resolution of symptoms. Conclusion: This caseemphasizes the importance of considering late postpartum eclampsia in patients presenting with signs of pulmonary edema even several days after delivery, as early diagnosis and prompt initiation of appropriate antihypertensive and anticonvulsant therapy can prevent severe complications.