This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas’ heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas’ disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 ± 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 ± 23 mm Hg, diastolic blood pressure 76 ± 11 mm Hg and resting heart rate 77 ± 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na⁺ was 140 ± 4 mEq/1, K⁺ was 4.34 ± 0.73 mEq/1 and creatinine level 1.34 ± 0.31 mg/l00 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 ± 0.16, left ventricular systolic dimension of 51.23 ± 13.53 mm and left ventricular diastolic dimension of 62.94 ± 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly. By univariate analysis, left ventricular ejection fraction (p = 0.03), left ventricular diastolic dimension (p = 0.03), NYHA class IV (p = 0.0004) and digitalis use (p = 0.04) were found to be associated with mortality. In the multivariate model, however, only left ventricular ejection fraction was retained as an independent predictor of mortality. Actuarial survival was 75% for patients with left ventricular ejection fraction > 0.30, and 40% for patients with left ventricular ejection fraction < 0.30 (p = 0.03). We conclude that patients with Chagas’ heart disease having a left ventricular ejection fraction < 0.30 determined echocardio-graphically are at very high risk of dying.

This review provides an overview of the clinicopathological aspects of chronic Chagas' heart disease, and a comprehensive view of predictors of mortality for chagasic patients with Chagas' cardiopathy in an attempt to help physicians with the management of their patients.

The medical records of 24 patients with Chagas disease who died suddenly, between 1982 and 1988, were examined in an attempt to determine the clinical profile of sudden death in Chagas disease. Patient age ranged from 33 to 72 years (average: 51). Seventeen (70%) were male: Five (20%) were asymptomatic. Dyspnoea at rest was observed in 16 (66%) and palpitations in eight (33%). On physical examination, arrhythmias were observed in 14 (58%), ankle swelling in 13 (54%) and liver enlargement in 12 (50%) patients. Twenty-three (95%) patients had an abnormal resting electrocardiogram: ventricular premature contractions were observed in 19 patients (79%) and a left anterior fascicular block in 14 (58%). The chest X-ray revealed cardiomegaly in 20 patients (82%), which was moderate in three (13%) and severe in 11 (45%). At autopsy, mean heart weight was 496 g. Dilatation of all cardiac chambers was detected in 22 (91%), and apical aneurysm in 19 (79%) patients. When compared with symptomatic patients, asymptomatic patients with Chagas disease had a higher frequency of normal physical examination (3/5 vs 1/19, P < 0.004), normal chest X-ray (3/5 vs 1/19, P < 0.01), and a lower heart weight (400 +/- 43 g vs 521.58 +/- 146.26 g, P < 0.03). The majority of patients with Chagas disease who die suddenly have severe underlying myocardial disease. In some of them, however, sudden cardiac death may occur in the presence of minimal, if any, heart involvement.

The aim of this study was to assess the peripheral and cardiac autonomic system by catecholamine measurements in patients with severe chagasic and nonchagasic heart failure. Fifteen chagasic and 16 nonchagasic patients were enrolled in the study. Plasma venous norepinephrine levels (pg/ml) were 397.26 ± 250.11 for chagasic and 660.05 ± 455.57 for nonchagasic patients (p > 0.05), plasma venous epinephrine levels 215.84 ± 254.04 for chagasic and 106.17 ± 65.90 for nonchagasic patients (p > 0.05), aortic root norepinephrine levels 435.46 ± 306.60 for chagasic and 668.16 ± 512.82 for nonchagasic patients (p > 0.05), aortic root epinephrine levels 300.33 ± 302.69 for chagasic and 199.98 ± 162.88 for nonchagasic patients (p > 0.05), coronary sinus norepinephrine levels 636.10 ± 495.22 for chagasic and 552.17 ± 535.54 for nonchagasic patients (p > 0.05) and coronary sinus epinephrine levels 226.66 ± 277.47 for chagasic and 69.21 ± 35.62 for nonchagasic patients (p = 0.02). Myocardial and peripheral norepinephrine and epinephrine extractions were similar for both groups. Taken together, these findings may suggest that chagasic patients with congestive heart failure have biochemical evidence of cardiac autonomic dysfunction with preservation of the peripheral sympathetic activity.