Development and Validation of a Risk Score for Predicting Death in Chagas' Heart Disease

Rassi, Anis; Little, William C.; Xavier, Sérgio Salles; Rassi, Sérgio Gabriel; Rassi, A.; Rassi, Gustavo Gabriel; Hasslocher‐Moreno, Alejandro Marcel; Sousa, Andréa Silvestre de; Scanavacca, Maurício

doi:10.1056/nejmoa053241

Cited by 551 publications

(565 citation statements)

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“…In Chagas' disease, AF has been considered a marker of poor prognosis of cardiac death (33), and other concomitant disease-related markers impose a higher risk for embolic stroke (34). In the present study, AF was associated with a non-significant increase in stroke risk.…”

Section: Discussionsupporting

confidence: 48%

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

Benchimol-Barbosa

Barbosa-Filho

2009

Braz J Med Biol Res

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Atrial fibrillation (AF) affects subjects with Chagas' disease and is an indicator of poor prognosis. We investigated clinical, echocardiographic and electrocardiographic variables of Chagas' disease in a long-term longitudinal study as predictors of a new-onset AF episode lasting >24 h, nonfatal embolic stroke and cardiac death. Fifty adult outpatients (34 to 74 years old, 62% females) staged according to the Los Andes classification were enrolled. During a follow-up of (mean ± SD) 84.2 ± 39.0 months, 9 subjects developed AF (incidence: 3.3 ± 1.0%/year), 5 had nonfatal stroke (incidence: 1.3 ± 1.0%/year), and nine died (mortality rate: 2.3 ± 0.8%/year). The progression rate of left ventricular mass and left ventricular ejection fraction was significantly greater in subjects who experienced AF (16.4 ± 20.0 g/year and -8.6 ± 7.6%/year, respectively) than in those who did not (8.2 ± 8.4 g/year; P = 0.03, and -3.0 ± 2.5%/year; P = 0.04, respectively). In univariate analysis, left atrial diameter ≥3.2 cm (P = 0.002), pulmonary arterial hypertension (P = 0.035), frequent premature supraventricular and ventricular contraction counts/ 24 h (P = 0.005 and P = 0.007, respectively), ventricular couplets/24 h (P = 0.002), and ventricular tachycardia (P = 0.004) were long-term predictors of AF. P-wave signal-averaged ECG revealed a limited long-term predictive value for AF. In chronic Chagas' disease, large left atrial diameter, pulmonary arterial hypertension, frequent supraventricular and ventricular premature beats, and ventricular tachycardia are long-term predictors of AF. The rate of left ventricular mass enlargement and systolic function deterioration impact AF incidence in this population.

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Section: Discussionsupporting

confidence: 48%

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

Benchimol-Barbosa

Barbosa-Filho

2009

Braz J Med Biol Res

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“…At the chronic phase, roughly 30% of patients present cardiac dysrhythmia, heart failure and thromboembolism (both systemic and pulmonary) (Rassi et al 2009). A depressed left-ventricular ejection fraction and increased left-ventricular internal dimensions have been shown to be associated with increased morbidity and mortality (Rassi et al 2006, Acquatella 2007.…”

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confidence: 99%

The benefits of using selenium in the treatment of Chagas disease: prevention of right ventricle chamber dilatation and reversion of Trypanosoma cruzi-induced acute and chronic cardiomyopathy in mice

Souza¹,

Jelicks²,

Tanowitz

et al. 2010

Mem. Inst. Oswaldo Cruz

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“…Rassi cols demonstraram, após análise multivariada, a relevância prognóstica dos achados de anormalidade contrátil segmentar ou global pela ecocardiografia, como preditores de risco de morte por causas cardiovasculares e morte súbita (hazard ratio de 2,46; p = 0,008). Embora os autores não tenham feito menção da FIDC, os dados refletem a importância prognóstica da identificação de anormalidade contrátil segmentar em pacientes chagásicos 10 .…”

Section: Discussionunclassified

Associação entre dissinergia miocárdica e arritmia ventricular na forma indeterminada da doença de Chagas

Barros

Ribeiro

Nunes

et al. 2011

Rev. Soc. Bras. Med. Trop.

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RESUMOIntrodução: Pacientes na forma indeterminada da doença de Chagas (FIDC) podem apresentar anormalidades contráteis segmentares, com evidências de pior prognóstico comparativamente a pacientes com estudo ecocardiográfico normal. O objetivo deste estudo foi de avaliar a associação entre a presença de anormalidade contrátil segmentar e a presença de distúrbios do ritmo cardíaco na FIDC. Métodos: Foram estudados 38 pacientes na FIDC, sendo 26 pacientes sem anormalidade contrátil e 12 com presença de distúrbio contrátil ao estudo ecocardiográfico. Todos os pacientes foram submetidos a um estudo ecocardiográfico completo, incluindo o Doppler tecidual, bem como à monitorização eletrocardiográfica de 24h (Holter). Resultados: Entre as diversas variáveis estudadas, foram encontradas diferenças significativas entre os dois grupos em relação à fração de ejeção (p ≤ 0,001), dimensão sistólica do ventrículo esquerdo (p = 0,029) e tempo de contração isovolumétrica (p < 0,05) medidos pela ecocardiografia e Doppler tecidual, bem como extrassistolia ventricular isolada (p = 0,016) e em pares (p = 0,003) pela avaliação pelo Holter. Conclusões: Pacientes na FIDC que apresentam anormalidades contráteis quando avaliados pela ecocardiografia apresentam episódios mais frequentes de extrassistolia ventricular, traduzindo um maior dano morfofuncional e elétrico do coração, quando comparados a pacientes que apresentem estudo ecocardiográfico normal. Palavras-chaves: Doença de Chagas. Ecocardiografia. Arritmia ventricular. ABSTRACTIntroduction: Chagas' disease can lead to severe and potentially lethal damage of cardiac function. Thus, the identification of cardiac abnormalities in patients presenting the indeterminate form (IF) can be important for risk stratification. This paper aimed to demonstrate whether IF chagasic patients who presented wall motion abnormalities showed functional and electric disturbances compared to patients with normal echocardiogram and Doppler studies. Methods: Thirty eight patients with the IF were studied, including 26 chagasic patients with normal electrocardiographic, radiological and echocardiographic exams and 12 chagasic patients showing segmental wall motion abnormalities in the echocardiographic exam. All the patients were submitted to complete echocardiogram and Doppler study, including tissue Doppler imaging (TDI) and Holter 24h monitoring. Results: Among the variables evaluated, significant differences among the two groups were verified in relation to: the ejection fraction (p ≤ 0.001); left ventricular systolic dimension (p = 0.029); isovolumic contraction time, measured by TDI in the basal segments of the left ventricle (p < 0.05); and the presence of isolated (p = 0.0005) and paired ventricular extrasystoles (p = 0.003), in the Holter monitoring. Conclusions: The indeterminate form of Chagas' disease can present cardiac wall motion abnormality, demonstrating functional and electric damage compared to chagasic patients with normal echocardiogram.

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Development and Validation of a Risk Score for Predicting Death in Chagas' Heart Disease

Abstract: A simple risk score was developed to predict death in Chagas' heart disease and was validated in an independent cohort.

Cited by 551 publications

References 17 publications

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

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

The benefits of using selenium in the treatment of Chagas disease: prevention of right ventricle chamber dilatation and reversion of Trypanosoma cruzi-induced acute and chronic cardiomyopathy in mice

Associação entre dissinergia miocárdica e arritmia ventricular na forma indeterminada da doença de Chagas

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