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Objectives: Hepatocyte growth factor (HGF) plays an important role in the improvement in cardiac function and remodeling in a variety of cardiovascular diseases. It is also a strong predictor of mortality in some heart failure (HF) patients. However, its prognostic value in patients with Chagas’ disease (CD) or idiopathic dilated cardiomyopathy (DCM) remains to be investigated. Methods and Results: In this prospective cohort study, HGF concentrations were measured in patients with CD (n = 91), DCM (n = 47), and control subjects (n = 25). While no difference was detected for patients with New York Heart Association class I–II, HGF was significantly increased in advanced HF patients (New York Heart Association class III–IV) in both CD and DCM groups, compared with healthy subjects. There was a strong correlation between HGF and left ventricular ejection fraction in CD patients. However, there was no correlation in patients with DCM. Despite its strong correlation with left ventricular ejection fraction in CD patients, HGF failed to predict mortality and necessity for heart transplant in both CD and DCM patients. Conclusions: Although HGF can be significantly increased in advanced HF patients with CD and DCM, its prognostic value for endpoints is minor. Therefore, the formerly described predictive power for HGF in HF might be restricted to specific etiologies of HF.

We have previously shown that a low-stringency single-specific primer-polymerase chain reaction (LSSP- PCR) is a highly sensitive and reproducible technique for the genetic profiling of Trypanosoma cruzi parasites directly in tissues from infected animals and humans. By applying LSSP-PCR to the study of the variable region of kinetoplast minicircle from T. cruzi, the intraspecific polymorphism of the kinetoplast-deoxyribonucleic acid (kDNA) sequence can be translated into individual kDNA signatures. In the present article, we report on our success using the LSSP-PCR technique in profiling the T. cruzi parasites present in the hearts of 13 patients with chagasic cardiopathy and in the esophagi of four patients (three of them with chagasic megaesophagus). In two patients, one with the cardiodigestive clinical form of Chagas disease and the other with cardiopathy and an esophageal inflammatory process, we could study both heart and esophagus and we detected distinct kDNA signatures in the two organs. This provides evidence of a differential tissue distribution of genetically diverse T. cruzi populations in chronic Chagas disease, suggesting that the genetic variability of the parasite is one of the determining factors of the clinical form of the disease.

Homem de 36 anos, com quadro de estenose aórtica crítica e choque cardiogênico refratário, foi submetido a valvuloplastia aórtica por balão como procedimento de salvamento, seguindo-se compensação clínica, o que possibilitou a realização de cirurgia de troca valvar aórtica no 48º dia após esse procedimento. O acompanhamento clínico e ecocardiográfico demonstrou melhora funcional significativa até o presente, oito meses após a cirurgia. A valvuloplastia aórtica por balão constitui opção terapêutica de salvamento em pacientes com estenose aórtica grave e elevado risco cirúrgico, servindo como ponte para a cirurgia de troca aórtica ou transplante cardíaco. A cirurgia de troca aórtica deve ser considerada, mesmo em pacientes com disfunção ventricular grave, reservando-se o transplante cardíaco aos pacientes em que se supõe depressão muito acentuada e irreversível da contratilidade miocárdica. In a 36-year-old man with severe aortic stenosis and refractory cardiogenic shock, an emergency percutaneous balloon aortic valvuloplasty was performed, followed by clinical improvement, allowing elective aortic valve replacement at the 48th day post-valvuloplasty. Clinical follow-up for eight months after surgery showed significant functional improvement. Aortic balloon valvuloplasty is a life-saving approach to patients with severe aortic stenosis and high surgical risk and should be considered as a bridge to planned valve replacement or cardiac transplantation. Aortic valve replacement should be considered even in patients with severe ventricular dysfunction, while the cardiac transplantation should be indicated for patients with a very marked and irreverssible depression of myocardial contractility.

Homem de 36 anos, com quadro de estenose aórtica crítica e choque cardiogênico refratário, foi submetido a valvuloplastia aórtica por balão como procedimento de salvamento, seguindo-se compensação clínica, o que possibilitou a realização de cirurgia de troca valvar aórtica no 48º dia após esse procedimento. O acompanhamento clínico e ecocardiográfico demonstrou melhora funcional significativa até o presente, oito meses após a cirurgia. A valvuloplastia aórtica por balão constitui opção terapêutica de salvamento em pacientes com estenose aórtica grave e elevado risco cirúrgico, servindo como ponte para a cirurgia de troca aórtica ou transplante cardíaco. A cirurgia de troca aórtica deve ser considerada, mesmo em pacientes com disfunção ventricular grave, reservando-se o transplante cardíaco aos pacientes em que se supõe depressão muito acentuada e irreversível da contratilidade miocárdica.