Predictors of Sudden Cardiac Death for Patients with Chagas’ Disease: A Hospital-Derived Cohort Study

Abstract

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.

Predictors of Mortality in Chronic Chagas Disease

“…Two articles from an external source were added to this overview: a manuscript that had just been accepted for publication in a peer-reviewed journal 23 and a relevant study (published as an abstract) 24 that was identified by searching for bibliographies in all retrieved articles. Thus, 12 studies [21][22][23][24][25][26][27][28][29][30][31][32] satisfied the prespecified inclusion and exclusion criteria and constitute the basis of this investigation. Table 1 summarizes the characteristics of the 12 studies.…”

“…Table 1 summarizes the characteristics of the 12 studies. Year of publication [21][22][23][24][25][26][27][28][29][30][31][32] ranged from 1991 to 2006. Investigators enrolled subjects over several years, and the most studies referred to Brazilian cohorts.…”

Sudden death in Chagas' disease

“…The risk of sudden death is obviously not the same for every chagasic patient; therefore, several authors 25,27,29,[30][31][32]50,[59][60][61][62][63][64][65][66][67][68][69][70][71][72] have tried to identify factors predisposing certain patients to a higher risk of this catastrophic event. Therefore, variables, such as presyncope and syncope, ventricular dysfunction and heart failure, complex nonsustained and sustained ventricular arrhythmias, severe bradyarrhythmias (sinus node dysfunction and advanced atrioventricular blocks), and previous cardiac arrest have been identified as predictors of the risk of sudden death, at least in some studies.…”

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

“…The systemic infection is generally acquired at an early age (6,7) by vector transmission, although an acute form of parasitic transmission has been increasingly reported in affected countries (8), and may represent a noteworthy healthcare-related problem in Europe and the United States due to migration (9). Its insidious and asymptomatic course, ranging from 10 to 30 years, and eventual advance to myocardial dysfunction, occurring in up to 30% of infected subjects, represents a marker of unfavorable prognosis for cardiovascular morbidity and mortality (10)(11)(12)(13). In this setting, persistent or permanent AF has been observed in up to one fifth of subjects bearing the chronic form (14) and represents a superimposed sign of poor prognosis (7,8).…”