Predictors of Mortality in Chronic Chagas Disease

Abstract

Background-Chagas disease is a major cause of morbidity and mortality in Latin America. Knowledge of the predictors of prognosis can help clinical decision making by identifying patients' level of risk. Methods and Results-We reviewed the published literature on prognostic factors in patients with Chagas disease by performing a PubMed search for articles published in any language between 1985 and February 2006 and hand searches of the reference lists of retrieved articles. Studies were selected if they included patients in the chronic phase of Chagas disease, analyzed a clearly defined outcome (all-cause mortality, sudden cardiac deaths, and/or cardiovascular deaths), and used multivariable regression models of prognosis. From 606 potentially relevant studies, 12 met the inclusion criteria: 8 clinic-based studies including 3928 patients and 4 hospital-based studies including 349 patients. Impaired left ventricular function by echocardiogram or cineventriculogram was found to be the most common and consistent independent predictor of death. New York Heart Association functional class III/IV and cardiomegaly on the chest radiography also were independently associated with higher mortality. More recently, strong evidence was found that nonsustained ventricular tachycardia on 24-hour Holter monitoring indicated an adverse prognosis. The typical ECG abnormalities showed limited additional prognostic value. Other often-mentioned risk factors, advanced age and male sex, showed inconsistent results. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. Conclusions-A systematic review of published studies indicates that impaired left ventricular function, New York HeartAssociation class III/IV, cardiomegaly, and nonsustained ventricular tachycardia indicate a poor prognosis in patients with chronic Chagas disease.

Por que os portadores de cardiomiopatia chagásica têm pior evolução que os não-chagásicos?

“…Rassi Jr. et al 13 performed a systematic literature review regarding predictors of mortality in patients with Chagas heart disease. By analyzing clinical trials published between 1985 and 2006, these authors found that impaired left ventricular function, NYHA functional class III or IV, cardiomegaly, and nonsustained ventricular tachycardia are associated with poor prognosis in patients with chronic Chagas disease.…”

Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification

“…In 2007, we published the first systematic review integrating the results of all studies on the chronic phase of Chagas disease that used multivariable regression models of prognosis and analysed a clearly defined outcome, such as all-cause mortality, sudden cardiac death or cardiovascular death (Rassi Jr et al 2007). From 606 potentially relevant studies published between 1985-2006, 12 articles met the inclusion criteria and were thereby selected for analysis (Espinosa et al 1991, Hagar & Rahimtoola 1991, Bestetti et al 1994, 1996, Carrasco et al 1994, Mady et al 1994, Garzon et al 1998, Rodriguez-Salas et al 1998, Leite et al 2003, Salles et al 2003, Viotti et al 2004, Rassi Jr et al 2006).…”

Chagas disease: Present status of pathogenic mechanisms and chemotherapy

“…First, 20% to 30% of Chagasic patients complain of chest pain resembling angina in location and character, but without relationship to effort and unrelieved by organic nitrates (Punukollu et al, 2007). Second, electrocardiograms of many patients show typical findings of ischemia, such as ST-T changes and abnormal Q waves (Bern et al, 2007;Punukollu et al, 2007;Rassi et al, 2007). However, coronary angiography in Chagas cardiomyopathy invariably demonstrates the absence of obstructive coronary disease (Marin-Neto et al, 2007;Torres et al, 1995).…”