Prognostic Factors in Severe Chagasic Heart Failure

Costa, Sérgio Henrique Nascente; Rassi, Salvador; Freitas, Elis Marra da Madeira; Gutierrez, Natália da Silva; Boaventura, Fabiana Miranda; Sampaio, Larissa Pereira da Costa; Silva, João Bastista Masson

doi:10.5935/abc.20170027

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…It is very common for patients in severe stage D to be unsuccessful and progress to death. Costa et al 25 investigated 60 patients with severe heart failure of originated from Chagas disease for 90 months. Most (88.3%) died during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Chronic Chagas cardiomyopathy: characterization of cases and possibilities of action in primary healthcare

et al. 2022

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Despite the drastic decrease in the incidence of Chagas disease in Brazil, past cases still greatly impact health services in the country. Thus, this study aimed to characterize Chagas disease cases regarding their cardiac staging and death prognosis and, based on that, to propose primary healthcare (PHC) case follow-ups. This is a cross-sectional study based on secondary data from the medical records of patients with chronic Chagas cardiomyopathy (CCC). A logistic regression was applied to estimate crude and adjusted odds ratios (OR). A total of 433 medical records were evaluated. More severe CCC cases were associated with a greater number of hospitalizations (OR = 3.41; 95%CI: 1.59-7.30) and longer hospitalization (OR = 3.15; 95%CI: 1.79-5.53). Cases with a higher risk of death were associated with a higher number of hospitalizations (OR = 1.92; 95%CI: 1.09-3.37), longer hospital stays (OR = 2.04; 95%CI: 1.30-3.18), and visits to the outpatient clinic (OR = 2.18; 95%CI: 1.39-3.41) and the emergency department of the assessed hospital (OR = 3.12; 95%CI: 1.27-7.66). Analyzing the medical records at two moments, 72.9% of the cases remained in the stages in which they were initially evaluated. Overall, 44.4% of cases were classified as mild to moderate risk of death and 68.3% as low ones. The cases classified in the most severe stages of CCC and with high or intermediate risk of death were associated with greater hospital dependence. However, most cases were classified as milder forms of the disease, with a low risk of death and clinical stability. These findings aim to promote the role of PHC as a protagonist in the longitudinal follow-up of CCC cases in Brazil.

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Section: Discussionmentioning

confidence: 99%

Chronic Chagas cardiomyopathy: characterization of cases and possibilities of action in primary healthcare

et al. 2022

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“…En los pacientes con serología positiva para Chagas se recomienda un estudio completo de monitorización ecocardiográfica [28][29][30] y Holter, independientemente del estado clínico y de las características del ECG. El valor predictivo negativo de estos criterios es demasiado bajo y no permite excluir los riesgos de fenómenos embólicos, arritmias graves o desarrollo de insuficiencia cardíaca 31,32 .…”

Section: Conclusionesunclassified

Aneurismas ventriculares en una población de pacientes con cardiomiopatía chagásica

Sirena¹,

Garillo²,

Villarroel-Ábrego³

et al. 2022

RCCAR

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Antecedentes: Los pacientes con enfermedad de Chagas pueden desarrollar cardiomiopatía crónica (CChC); los aneurismas ventriculares son característicos de esta condición. Objetivo: Analizar una población de pacientes con CChC con aneurismas ventriculares, buscando asociaciones entre las variables sexo, edad, síntomas, fracción de eyección del ventrículo izquierdo (FEVI), tamaño de los aneurismas y presencia de arritmias ventriculares. Método: Los pacientes fueron valorados con historia clínica, electrocardiografía (ECG), radiología, ecocardiografía y Holter. Resultados: De 627 pacientes con CChC, 60 (9.6%) presentaron aneurismas (60%). Había una relación significativa entre edad mayor de 50 años y FEVI normal. El valor predictivo negativo de clase funcional I y ECG sin anomalías del QRS para detectar FEVI < 50% o taquicardia ventricular fue del 47.4%. No hubo relación significativa entre anomalías del QRS con FEVI < 50% ni taquicardia ventricular. Los aneurismas grandes estaban asociados a FEVI < 50%, pero no fueron predictores de taquicardia ventricular. No hubo asociación significativa entre volúmenes de fin de diástole del ventrículo izquierdo y FEVI o taquicardia ventricular; los pacientes en fase B1-2 no presentaron mayor riesgo de taquicardia ventricular que los de fase C-D. Conclusiones: En los pacientes con CChC se recomienda un estudio integral con ecocardiografía y Holter; el valor predictivo negativo de la clínica y del electrocardiograma es muy reducido.

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“…Chagas Disease (ChD) represents an important cause of heart failure in endemic countries . Almost half of all seropositive Trypanosoma cruzi individuals will ultimately develop Chagas cardiomyopathy (CCM) within two or three decades after the initial infection .…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic parameters, speckle tracking, and brain natriuretic peptide levels as indicators of progression of indeterminate stage to Chagas cardiomyopathy

et al. 2020

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Background Chronic Chagas cardiomyopathy (CCM) is characterized by a unique type of cardiac involvement. Few studies have characterized echocardiographic (Echo) transitions from the indeterminate Chagas disease (ChD) form to CCM. The objective of this study was to identify the best cutoffs in multiple Echo parameters, speckle tracking, and N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) to distinguish patients without CCM (stage A) vs patients with myocardial involvement (stages B, C, or D). Methods Cross‐sectional study conducted in 273 consecutive patients with different CCM stages. Echo parameters, NT‐proBNP, and other clinical variables were measured. Logistic regression models (dichotomized in stage A versus B, C, and D) adjusted for age, sex, body mass index, and NT‐proBNP were performed. Results Left ventricular global longitudinal strain (LV‐GLS), mitral flow E velocity, LV mass index, and NT‐proBNP identified early changes that differentiated stages A vs B, C, and D. The LV‐GLS with a cutoff −20.5% showed the highest performance (AUC 92.99%; accuracy 84.56% and negative predictive value (NPV) 88.82%), which improved when it was additionally adjusted by NT‐proBNP with a cutoff −20.0% (AUC 94.30%; accuracy 88.42% and NPV 93.55%). Conclusions Our findings suggest that Echo parameters and NT‐proBNP may be used as diagnostic variables in detecting the onset of myocardial alterations in patients with the indeterminate stage of ChD. LV‐GLS was the more accurate measurement regarding stage A differentiation from the stages B, C, and D. Prospective longitudinal studies are needed to validate these findings.

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Prognostic Factors in Severe Chagasic Heart Failure

Cited by 8 publications

References 19 publications

Chronic Chagas cardiomyopathy: characterization of cases and possibilities of action in primary healthcare

Chronic Chagas cardiomyopathy: characterization of cases and possibilities of action in primary healthcare

Aneurismas ventriculares en una población de pacientes con cardiomiopatía chagásica

Echocardiographic parameters, speckle tracking, and brain natriuretic peptide levels as indicators of progression of indeterminate stage to Chagas cardiomyopathy

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