Comportamiento de la técnica ELISA de competición en el diagnóstico de anemia infecciosa equina (AIE)

La AIE es una enfermedad causada por un virus específico de los équidos, capaz de inducir una considerable morbilidad y mortalidad. Además, los animales infectados permanecerán en esa condición por el resto de su vida. El objetivo fue evaluar el comportamiento de la técnica de ELISAc en comparación con la IDGA (inmunodifusión en gel de agar) para el diagnóstico serológico de AIE en equinos provenientes de zonas endémicas del nordeste argentino. El trabajo se realizó con 94 muestras de equinos de diferentes establecimientos del nordeste argentino, zona en la cual la enfermedad es endémica. Se llevó a cabo el diagnóstico por medio de la técnica de IDGA y luego por la técnica de ELISAc de competencia. Se llevó a cabo el análisis de característica operativa del receptor y de concordancia (ROC). Se obtuvieron 66 resultados negativos y 28 positivos en cada una de las técnicas. Las concordancias entre la técnica de ELISAc comparándola con la de referencia IDGA con un nivel de confianza del 95%, arrojó un coeficiente Kappa de 0,89. El análisis ROC entre IDGA y ELISAc reveló que con una sensibilidad (Se) del 100% y una especificidad (Sp) del 95,45%, de las 28 muestras positivas para IDGA, 26 resultaron positivas para ELISAc. El área bajo la curva (AUC) obtenido fue de 0,997 y el índice de Youden fue de 0,95, demostrando que es una técnica eficaz para el diagnóstico de AIE en las condiciones evaluadas, teniendo en cuenta ello y sabiendo la importancia que tiene contar con un diagnostico efectivo y rápido para mejorar las situaciones contra la lucha de esta enfermedad, siendo de gran importancia poder incorporar la pericia en la rutina diaria, principalmente como técnica screening para esta enfermedad

Mode of death on Chagas heart disease: comparison with other etiologies. a subanalysis of the REMADHE prospective trial.

Sudden death has been considered the main cause of death in patients with Chagas heart disease. Nevertheless, this information comes from a period before the introduction of drugs that changed the natural history of heart failure. We sought to study the mode of death of patients with heart failure caused by Chagas heart disease, comparing with non-Chagas cardiomyopathy.We examined the REMADHE trial and grouped patients according to etiology (Chagas vs non-Chagas) and mode of death. The primary end-point was all-cause, heart failure and sudden death mortality; 342 patients were analyzed and 185 (54.1%) died. Death occurred in 56.4% Chagas patients and 53.7% non-Chagas patients. The cumulative incidence of all-cause mortality and heart failure mortality was significantly higher in Chagas patients compared to non-Chagas. There was no difference in the cumulative incidence of sudden death mortality between the two groups. In the Cox regression model, Chagas etiology (HR 2.76; CI 1.34-5.69; p = 0.006), LVEDD (left ventricular end diastolic diameter) (HR 1.07; CI 1.04-1.10; p<0.001), creatinine clearance (HR 0.98; CI 0.97-0.99; p = 0.006) and use of amiodarone (HR 3.05; CI 1.47-6.34; p = 0.003) were independently associated with heart failure mortality. LVEDD (HR 1.04; CI 1.01-1.07; p = 0.005) and use of beta-blocker (HR 0.52; CI 0.34-0.94; p = 0.014) were independently associated with sudden death mortality.In severe Chagas heart disease, progressive heart failure is the most important mode of death. These data challenge the current understanding of Chagas heart disease and may have implications in the selection of treatment choices, considering the mode of death.ClinicalTrials.gov NCT00505050 (REMADHE)

Characteristics of the study population.

<p>Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BMI, body mass index; CrCl, creatinine clearance; NYHA, New York Heart Association functional class; IQR, interquartile range; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end diastolic diameter.</p>*<p>Information available in 296 patients.</p

Follow-up comparisons between groups.

<p>Abbreviations: IQR, interquartile range.</p

Cox proportional hazard analysis of risk factors at baseline for heart failure mortality.

<p>Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BMI, body mass index; CrCl, creatinine clearance; EC, emergency care; Hosp, hospitalization; NYHA, New York Heart Association functional class; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end diastolic diameter; NA: not applicable; NS: not significant;</p>a<p>NYHA class III/VI vs NYHA class I/II;</p>b<p>Chagas vs non Chagas;</p>c<p>beta-blocker vs no beta-blocker;</p>d<p>ACEI/ARB vs no ACEI/ARB;</p>e<p>spironolactone vs no spironolactone;</p>f<p>amiodarone vs no amiodarone;</p>g<p>disease management program vs control;</p>h<p>Model 1 not incorporated NYHA functional class and Model 2 included NYHA functional class (information available in 296 patients).</p

Cumulative incidence of heart failure mortality rate in Chagas and non-Chagas patients.

<p>Cumulative incidence of heart failure mortality rate in Chagas and non-Chagas patients.</p

Flow diagram of the REMADHE trial.

<p>Flow diagram of the REMADHE trial.</p

Cumulative incidence of all-cause mortality rate in Chagas and non-Chagas patients.

<p>Cumulative incidence of all-cause mortality rate in Chagas and non-Chagas patients.</p

Cumulative incidence of sudden death mortality rate in Chagas and non-Chagas patients.

<p>Cumulative incidence of sudden death mortality rate in Chagas and non-Chagas patients.</p

Cox proportional hazard analysis of risk factors at baseline for sudden death mortality.

<p>Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BMI, body mass index; CrCl, creatinine clearance; EC, emergency care; Hosp, hospitalization; NYHA, New York Heart Association functional class; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end diastolic diameter; NA: not applicable; NS: not significant;</p>a<p>NYHA class III/VI vs NYHA class I/II;</p>b<p>Chagas vs non Chagas;</p>c<p>beta-blocker vs no beta-blocker;</p>d<p>ACEI/ARB vs no ACEI/ARB;</p>e<p>spironolactone vs no spironolactone;</p>f<p>amiodarone vs no amiodarone;</p>g<p>disease management program vs control;</p>h<p>Model 1 not incorporated NYHA functional class and Model 2 included NYHA functional class (information available in 296 patients).</p