Background: Inflammation plays a critical role in coronary heart disease progression. Low-dose colchicine has shown promise in reducing cardiovascular events, and Green Brazilian propolis extract (EPP-AF®), with anti-inflammatory properties, may offer benefits in its treatment. This pilot study evaluates whether six weeks of EPP-AF improves functional capacity assessed by treadmill test. Methods: the PRAIA trial was a randomized, double-blind, placebo-controlled pilot study conducted at a coronary disease clinic in an outsourced center in Brazil. Patients aged ≥18 years with stable coronary artery disease, receiving optimized medical therapy, were randomized 2:1 to receive either 200 mg of EPP-AF® or placebo twice daily for six weeks. The primary outcome was the change, measured in seconds, in treadmill exercise duration. Secondary outcomes included total exercise time, METs, hs-CRP levels, Seattle Angina Questionnaire (SAQ), and CCS score. Statistical analysis was performed on an intention-to-treat basis. Results: A total of 59 patients were randomized, with a median follow-up of 6.5 weeks. The primary endpoint, median change in treadmill test time, showed no difference between the propolis (39 seconds) and placebo (30 seconds) groups (p = 0.83). There were no improvements in functional capacity, hs-CRP levels, or angina symptoms assessed by SAQ in the propolis group. No major adverse cardiovascular events occurred during the study. Conclusion: EPP-AF® did not improve functional capacity, inflammation markers, or angina symptoms assessed by SAQ in patients with stable coronary artery disease compared to placebo.

Chagas cardiomyopathy is the most prevalent non-ischemic cardiomyopathy in Latin America, with high morbidity and mortality even today. Treatment of these patients is based on the use of medications for heart failure. This study evaluated a cohort of patients with Chagas heart disease who used sacubitril valsartan at a referral hospital for the disease in Brazil. After six months, there was a symptomatic improvement in these individuals assessed by the NYHA classification, with a 44.3% reduction in the absolute number of patients classified as III-IV in the period (p 0.035), but without changes in the parameters on the echocardiogram for reverse ventricular remodeling and still high mortality rate and hospitalization. These results emphasize the importance of studying the use of sacubitril valsartan in chagas heart disease to better describe its effectiveness taking into account the peculiarities of these individuals.

Introduction: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) patients with left bundle branch block (LBBB). However, the benefits of CRT in patients with previous pacing are uncertain, specially in a population witch Chagas disease is a prevalent cause of HF. Methods and Results: Prospective cohort study that included HF patients indicated for CRT with left ventricular ejection fraction (LVEF) of less than 35%. Clinical and demographic data were collected to investigate mortality predictors after 1 year. The overall survival was calculated by the Kaplan-Meier method and multivariate analysis using Cox’s regression model was performed. Between May 2017 and September 2019, 93 patients were evaluated with a mean follow-up of 1,0 (0.6) year. Of these, 22 (23,7%) were upgraded from right ventricular pacing. Chagas Disease was the most prevalent cause of HF 29 (31,2%). In overall patients, LVEF at 6 months increased after CRT: 24,0% (7,8) to 30,3% (11,5), p=0.007, and there was no significant difference between upgraded patients and de Novo CRT, p=0.26. Overall mortality at 1-year was 28 (30,1%). In the univariate analysis, Chagas disease and upgraded therapy were associated with mortality at follow-up, HR: 3.9, CI: 1.8-8,4, p = 0.001 and HR: 4.7, CI: 2.2-9.9, p < 0.001, respectively. In the multivariate model, only upgraded therapy remained independently associated with the outcome, adjusted HR: 2.9, CI: 1.2-7,2, p = 0.02. Conclusion: In this specific HF population, with a high prevalence of Chagas disease cardiomyopathy, upgraded therapy was independently associated with worsened 1-year survival after CRT.