This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas’ heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas’ disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 ± 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 ± 23 mm Hg, diastolic blood pressure 76 ± 11 mm Hg and resting heart rate 77 ± 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na+ was 140 ± 4 mEq/1, K+ was 4.34 ± 0.73 mEq/1 and creatinine level 1.34 ± 0.31 mg/l00 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 ± 0.16, left ventricular systolic dimension of 51.23 ± 13.53 mm and left ventricular diastolic dimension of 62.94 ± 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly. By univariate analysis, left ventricular ejection fraction (p = 0.03), left ventricular diastolic dimension (p = 0.03), NYHA class IV (p = 0.0004) and digitalis use (p = 0.04) were found to be associated with mortality. In the multivariate model, however, only left ventricular ejection fraction was retained as an independent predictor of mortality. Actuarial survival was 75% for patients with left ventricular ejection fraction > 0.30, and 40% for patients with left ventricular ejection fraction < 0.30 (p = 0.03). We conclude that patients with Chagas’ heart disease having a left ventricular ejection fraction < 0.30 determined echocardio-graphically are at very high risk of dying.
This study was carried out to identify patients with Chagas’ disease at risk of sudden cardiac death, inasmuch as such patients have not been recognized thus far. Seventy-four consecutive patients with a positive complement fixation test for Chagas’ disease prospectively followed up at the Cardiomyopathy Clinic from January 1990 to June 1993 were entered into the study. Patients underwent medical history, physical examination, serological tests, resting electrocardiography, chest X-ray and two-dimensional echocardiography. Eighteen of 74 (24%) patients died during the study period, 8 (10%) suddenly and 10 (14%) from pump failure. Sudden death comprised 44% of total deaths. In the univariate model, cardiomegaly in the chest X-ray, left ventricular systolic and diastolic dimension, left ventricular ejection fraction, left atrial dimension and apical aneurysm as detected echocardiographically, and systolic blood pressure were associated with sudden cardiac death. In the multivariate model, however, apical aneurysm and left ventricular diastolic dimension were retained as predictors of sudden cardiac death. We conclude that chagasic patients with apical aneurysm and left ventricular dilation are at risk of sudden cardiac death.
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