Objective Systolic dysfunction is a well‐established marker of mortality in patients with Chagas cardiomyopathy (CC). However, its diagnosis is expensive and useful tools for screening these patients are required. The evaluation of the health‐related quality of life (HRQoL) detects the patient’s perception of the disease’s impact. However, its accuracy in identifying patients with CC and systolic dysfunction is unknown. The study aimed to verify the sensitivity, specificity and predictive values of the physical and mental components related to HRQoL in identifying patients with CC and systolic dysfunction. Methods 75 patients with CC, aged 49 (95% confidence interval: 47–51) years, were evaluated by echocardiography and Short‐Form of Health Survey (SF‐36) questionnaire. Systolic dysfunction was defined by left ventricular ejection fraction <52% for men and <54% for women and left ventricular diastolic diameter >55 mm. Results Most patients (73%) had systolic dysfunction, with lower HRQoL values in the physical functioning, physical role functioning and general health perceptions domains and in the physical component summary. The accuracy of identifying patients with systolic dysfunction by the scores of physical components was 73% and 62% of mental components. The optimal cut‐off point was 46 for physical and 54 for mental components, with respective positive predictive values of 91% and 80%. Conclusion The evaluation of the HRQoL by the SF‐36, a low‐cost instrument, can be useful in identifying patients with systolic dysfunction, assisting in the screening and risk stratification of patients.

Endemic Chagas diseaseis a major health concernin LatinAmerica. Ventricular arrhythmias (VA) is a hallmark of Chagas cardiomyopathy (ChC) associated with worse prognosis. To verify if there is an association between myocardial mechanical dispersion and ventricular arrhythmogenicity in CCM. This is a cross-sectional study involving 77 patients with CCM. Global longitudinal strain (GLS) and MD were evaluated by echocardiogram, derived from the speckle tracking technique. Myocardial MD was measured from the onset of the Q / R wave on electrocardiogram to the peak longitudinal strain in 16 segments of the left ventricle. Frequency and complexity of ventricular extrasystoles (VES) were assessed by dynamic electrocardiography. The density and complexity of VES and the presence of non-sustained ventricular tachycardias (NSVTs) increase as MD increases. In logistic regression, MD was the only variable associated with the presence of VES in pairs and bigeminy. In the univariate analysis, both MD and GLS were associated with the presence of NSVT (both, p < 0.01), and MD was independently associated with NSVT (OR 1.04, 95% CI: 1.004-1.201, p = 0.031). In Chagas cardiomyopathy, MD is associated with a higher density and complexity of ventricular extrasystoles, including NSVT.

BackgroundInadequate response to treatment in early rheumatoid arthritis (RA) is associated with adverse consequences. We have previously shown high baseline levels of disease activity in Latin American RA patients.1 ObjectivesTo identify the baseline predictive factors of inadequate response to treatment in patients with early RA from a GLADAR cohort, at one year from cohort entry.MethodsGLADAR cohort includes 1093 consecutive RA patients with disease <1 year from 46 centres in 14 Latin American countries. For these analyses, patients with complete clinical and laboratory assessments with DAS28-ESR>3.2 at the baseline, and one-year follow up visits were included. Inadequate treatment response was ascertained with the EULAR definition which is based on DAS28-ESR obtained at one-year of follow up [a variation ≤0.6 in any category of activity (mild, moderate or severe) and a variation >0.6 but≤1.2 in the high activity category]. Gender, age at diagnosis, diagnosis delay, socioeconomic status (by the Graffar scale), ethnicity, medical coverage, rural origin, rheumatoid factor (RF) positivity, disability (HAQ-DI), DMARDs use, corticosteroid use, and DMARD treatment delays were examined as potential predictive factors of this outcome. Univariable and multivariable binary logistic regression models, using a stepdown technique were examined in order to determine the predictors of response at 1 year.ResultsFour hundred and forty-eight patients were included. Three hundred and eighty-five (85.9%) were female; the mean (SD) age at diagnosis was 46.1 (13.6) years; 78.3% had medical coverage and 347 patients (77.5%) were RF positive. The mean baseline DAS28-ESR was 6.3 (1.4). EULAR response was met by 347 (77.5%) patients at 1 year. Three hundred patients (67%) have received glucocorticoids, 78.8% at least one DMARD and only 1.1% had received at least one biologic compound. The baseline HAQ-DI was 1.5 (0.0–3.0). Predictors of non-EULAR response at 1 year were: female gender (OR=2.4; CI:1.0–5.6; p=0.039), a higher baseline HAQ-DI (OR=1.7; CI:1.2–2.4; p=0.003) whereas protective factors were higher DAS28-ESR (OR=0.6; CI:0.4–0.7; p<0.001) and having medical coverage (OR=0.5; CI:0.3–0.9; p=0.025).ConclusionsWe have identified baseline predictors of adverse response to treatment in LA patients with early RA. Absence of medical coverage seems to be an additional adverse factor associated with poor results. Other factors such as early response/remission or adherence to treatment should be taken into account.Reference[1] Massardo L. Arthritis Care Res (Hoboken)2012;64(8):1135–4.Disclosure of InterestNone declared

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