T-Wave Amplitude Variability and the Risk of Death in Chagas Disease

Ribeiro, Antônio Luiz Pinho; Rocha, Sofia; Terranova, P; Cesarano, Marco; Nunes, Sabrina Versuti; Lombardi, Federico

doi:10.1111/j.1540-8167.2010.02000.x

Cited by 36 publications

(35 citation statements)

References 41 publications

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“…Thus, clinical indicators such as EKG or echocardiography may provide valuable end-points to evaluate progressive cardiac damage and vaccine efficacy. 82,83 Also, such clinical indicators may be able to detect difference in disease progression rate within a reasonable time, as suggested by studies in dogs 66,67,84 and in patient follow-up evaluations. 82,83,85 In that respect, much can be learned from the current "BENEFIT" trial, which is evaluating the efficacy of drug treatment in chronicstage patients.…”

Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 90%

“…82,83 Also, such clinical indicators may be able to detect difference in disease progression rate within a reasonable time, as suggested by studies in dogs 66,67,84 and in patient follow-up evaluations. 82,83,85 In that respect, much can be learned from the current "BENEFIT" trial, which is evaluating the efficacy of drug treatment in chronicstage patients. Nonetheless, ongoing efforts for the identification of additional biomarkers are underway, including electrocardiographic, immunologic and biochemical markers, which may greatly improve and facilitate the monitoring of Chagas disease progression and thus vaccine evaluation.…”

Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 90%

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Advances and challenges towards a vaccine against Chagas disease

Quijano-Hernández

Dumonteil

2011

Human Vaccines

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Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 90%

Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 90%

Advances and challenges towards a vaccine against Chagas disease

Quijano-Hernández

Dumonteil

2011

Human Vaccines

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“…Na cidade de Niterói, 64 Recentemente se demonstrou que escore eletrocardiográfico tem correlação positiva com fibrose miocárdica e correlação negativa com a fração de ejeção de ventrículo esquerdo (FEVE) em pacientes com cardiomiopatia chagásica 14 . Também a variabilidade de amplitude da onda T em pacientes chagásicos foi relacionada a pior prognóstico 15 .…”

Section: Epidemiologiaunclassified

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Bocchi

Marcondes‐Braga²,

Bacal³

et al. 2012

Arq. Bras. Cardiol.

219

206

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Esta atualização da Diretriz de Insuficiência Cardíaca Crônica (IC) - 2012 surge para reavaliar as recomendações através de uma avaliação criteriosa das pesquisas (considerando-se a qualidade dos estudos), fundamental para que se atinja esse propósito. Para tanto, foi dada ênfase ao efeito em desfechos de morte, à qualidade "CONSORT" (Consolidated Standards of Reporting Trials), à descrição qualitativa e quantitativa da otimização da medicação, à população realmente incluída, às metanálises somente de estudos qualidade "CONSORT", à custo-efetividade, à existência de efeito de classe, ao número de pacientes incluídos e à análise de subgrupos apenas para gerar hipóteses. Na área da epidemiologia, as recentes abordagens das características da IC com fração de ejeção preservada (ICFEP) e da importância da IC como causa de morte no Brasil foram revisadas. Além disso, este documento contempla a reavaliação do valor dos biomarcadores no diagnóstico e no seguimento da IC, o papel diagnóstico da angiotomografia coronariana nos casos de risco intermediário ou baixo risco de doença coronariana, a não recomendação de rotina do telemonitoramento; o surgimento da avaliação familiar como recomendação importante, e a reavaliação da restrição da adição de sal na dieta. As clínicas de IC e reabilitação física, apesar de alguns resultados negativos ou controversos quanto à mortalidade, continuam com recomendação importante. No campo do tratamento farmacológico, abrange-se a reavaliação da indicação do nebivolol, introduz-se a ivabradina como um novo paradigma no tratamento, os antagonistas da aldosterona não têm efeito de classe reconhecido, o ômega 3 passa a ser recomendado, o ferro administrado por via endovenosa e o sildenafil recebem indicação em casos selecionados. Todas as recomendações para outras etiologias são expandidas para a Doença de Chagas. Na área da anticoagulação, recomenda-se a utilização dos escores CHA2DS2VASC e o HAS-BLED na fibrilação atrial, com introdução de inibidores da trombina e do fator Xa como alternativas na anticoagulação. No tratamento cirúrgico da IC, considerou-se que resultados neutros do estudo STICH influenciaram as recomendações, o transplante cardíaco continua a ser o tratamento indicado nas fases evolutivas tardias de IC, os dispositivos de assistência circulatória mecânica para terapia de destino passam a ter recomendação, a duração do QRS foi fundamental na indicação de TRV-AV, e o CDI continua com recomendação I para miocardiopatia isquêmica. Entretanto, baseada em análise crítica dos estudos considerando-se o custo-efetividade, o CDI não atingiu recomendação I para classes menos graves devido as limitações dos estudos. Também a importância da cardiotoxicidade por drogas para tratamento de neoplasias foi ressaltada, o tratamento da IC na gravidez e da miocardite foi revisado. Novos potenciais métodos de tratamento em fase de pesquisa são apresentados e novos fluxogramas de diagnóstico e tratamento da IC, reformulados, foram incluído

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“…Moreover, in another study performed in the same study sample, T-wave axis deviation was a strong and independent predictor of mortality risk. Furthermore, T-wave amplitude variability index, a marker of repolarization variability, is related to the risk of death in ChD, independent of other established risk factors (6) . The presence of late potentials on signal-averaged ECG, a marker of the presence of slow conduction regions, is related to a higher risk of death (7) , as is an increased dispersion of repolarization times in patients with ChD in both univariate and multivariate survival analyses (8) .…”

Section: Electrocardiographic Techniquesmentioning

confidence: 99%

New predictors of malignant ventricular arrhythmias in Chagas disease: searching for the holy grail

Barros

2015

Rev. Soc. Bras. Med. Trop.

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(Carlos Chagas, 1916) (1) Since the fi rst descriptions of Chagas disease (ChD), sudden death is considered one of the characteristics and responsible for >50% of the mortality in chagasic patients with heart failure. In this issue of RSBMT, Barbosa et al (2) . highlight several important aspects of the pathogenesis, prognosis, and treatment of ventricular arrhythmias in ChD (2) . Chagas disease has an essentially arrhythmogenic nature characterized by dense and complex ventricular arrhythmias; therefore, ventricular fi brillation likely constitutes the terminal event in most cases of sudden death, which accounts for the majority of deaths in ChD. Chagas cardiomyopathy gives rise to the most intense fi brous reaction amongst all causes of myocarditis, leading to severe disorganization of the myocardial architecture and structure. In addition to the fi brotic substrate, electrical dispersion plays an important role in arrhythmogenesis, and it is caused by areas of slow conduction leading to electrical instability. Myocardial fi brosis and areas of slow electrical conduction result in mechanical alterations in both timing and function. With the development of therapeutic strategies to prevent death from ventricular fi brillation, particularly the use of implantable cardioverter-defi brillators (ICDs), accurate patient stratifi cation based on the future risk of arrhythmic events has become very relevant in ChD (3) .A major therapeutic goal in the management of Chagas cardiomyopathy is prevention of sudden cardiac death. While ICD therapy is the standard treatment for secondary prevention of cardiac arrest, the strategy for primary prevention of cardiac arrest in Chagas cardiomyopathy is much more controversial. Although several clinical features have been assessed as possible risk factors for the development of fatal arrhythmias, the sensitivity and specifi city of any single test to predict fatal arrhythmias are limited. For example, left ventricular dysfunction is recognized as a strong general risk predictor, particularly for arrhythmic death in ChD (4) ; however, the mere presence of a depressed left ventricular ejection fraction (LVEF) is not sensitive or specifi c enough to stratify the risk of sudden death. Most patients with ChD that have an ICD for secondary prevention and thus have experienced a potentially fatal arrhythmic event have an LVEF >30%. Electrocardiographic techniquesIn the last few years, several new electrocardiographic methods have been used to predict mortality in ChD including measurement of the length of the QRS and QT intervals from a standard 12-lead ECG, which is a simple and inexpensive method of risk assessment in ChD. QT dispersion is associated with left ventricular (LV) systolic dysfunction, and both increased QT dispersion and QT interval are related to a higher risk of death in ChD patients (5) . Moreover, in another study performed in the same study sample, T-wave axis deviation was a strong and independent predictor of mortality risk. Furthermore,

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T-Wave Amplitude Variability and the Risk of Death in Chagas Disease

Abstract: Repolarization variability, evaluated by TWV, is independently related to the risk of death in ChD. This noninvasive methodology could facilitate the identification of patients who may benefit from more aggressive therapeutic strategies.

Cited by 36 publications

References 41 publications

Advances and challenges towards a vaccine against Chagas disease

Advances and challenges towards a vaccine against Chagas disease

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

New predictors of malignant ventricular arrhythmias in Chagas disease: searching for the holy grail

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