Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Arruda, Ana Lúcia Martins; Hotta, Viviane Tiemi; Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador

doi:10.5935/abc.20140003

Cited by 13 publications

(18 citation statements)

References 17 publications

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“…Consistent with the literature, we found the highest rates of mortality in patients in Stage D, the most severe stage of cardiomyopathy based on left ventricular dilatation and ejection fraction. Stage D T. cruzi infected individuals experienced 40% mortality over 14 months, similar to other studies of severe CCM (19). By restricting the analysis to patients in Stage D, we effectively examined the additive predictive value of the serum biomarkers beyond the clinical indicators already identified in many previous studies (10-12) (13) (14, 15) (9).…”

Section: Discussionsupporting

confidence: 87%

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Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Sherbuk

Okamoto

Marks

et al. 2015

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Background Chagas cardiomyopathy is a chronic sequela of infection by the parasite, Trypanosoma cruzi. Advanced cardiomyopathy is associated with a high mortality rate, and clinical characteristics have been used to predict mortality risk. Though multiple biomarkers have been associated with Chagas cardiomyopathy, it is unknown how these are related to survival. Objectives Our study aimed to identify biomarkers associated with mortality in individuals with severe Chagas cardiomyopathy in an urban Bolivian hospital. Methods The population included individuals with and without T. cruzi infection recruited in an urban hospital in Santa Cruz, Bolivia. Baseline characteristics, ECG findings, medications, and serum cardiac biomarker levels (BNP, NTproBNP, CKMB, troponin I, MMP-2, MMP-9, TIMP-1, TIMP-2, TGFb1, and TGFb2) were ascertained. Echocardiograms were preferentially performed on those with cardiac symptoms or electrocardiogram abnormalities. Participants were contacted by phone approximately 1 year after initial evaluation; deaths were reported by family members. Receiver operating characteristic curves were used to optimize cut-off values for each marker. For markers with area under curve > 0.55, Cox proportional hazards models were performed to determine the hazards ratio (HR) and 95% confidence interval (CI) for the association of each marker with mortality. Results The median follow-up time was 14.1 months (interquartile range 12.5- 16.7 months). Of 254 individuals with complete cardiac data, 220 (87%) had follow-up data. Of 50 patients with severe Chagas cardiomyopathy, 20 (40%) had died. Higher baseline levels of BNP (HR[95% CI]:3.1 [1.2, 8.4]), NTproBNP (4.4[1.8,11.0]), CKMB (3.3[1.3, 8.0]), and MMP-2 (4.2[1.5, 11.8]) were significantly associated with subsequent mortality. Conclusions Severe Chagas cardiomyopathy is associated with high short-term mortality. BNP, NTproBNP, CKMB and MMP2 have added predictive value for mortality, even in the presence of decreased ejection fraction and other clinical signs of congestive heart failure.

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Section: Discussionsupporting

confidence: 87%

“…Other less consistently identified risk factors include older age and male sex (11) (12) (14) (13) (16) (17). In recent retrospective study including only individuals with severe cardiomyopathy, low ejection fraction did not show further predictive value for mortality within this severely ill group (18) (19). …”

Section: Introductionmentioning

confidence: 92%

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Sherbuk

Okamoto

Marks

et al. 2015

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“…This study used the cut-off point of 72 mL/m 2 , similarly to that determined by Rassi et al, 19 who identified, by using the ROC curve, 70,71 mL/m 2 as the best cut-off point. 20 …”

Section: Discussionmentioning

confidence: 99%

“…Of the 20 echocardiographic parameters studied, ILAV proved to be the only independent predictor of cardiovascular mortality in patients with Chagasic HF. 20 , 21 …”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Severe Chagasic Heart Failure

Costa

Rassi

Freitas

et al. 2017

Arquivos Brasileiros De Cardiologia

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BackgroundPrognostic factors are extensively studied in heart failure; however, their role in severe Chagasic heart failure have not been established.ObjectivesTo identify the association of clinical and laboratory factors with the prognosis of severe Chagasic heart failure, as well as the association of these factors with mortality and survival in a 7.5-year follow-up.Methods60 patients with severe Chagasic heart failure were evaluated regarding the following variables: age, blood pressure, ejection fraction, serum sodium, creatinine, 6-minute walk test, non-sustained ventricular tachycardia, QRS width, indexed left atrial volume, and functional class.Results53 (88.3%) patients died during follow-up, and 7 (11.7%) remained alive. Cumulative overall survival probability was approximately 11%. Non-sustained ventricular tachycardia (HR = 2.11; 95% CI: 1.04 - 4.31; p<0.05) and indexed left atrial volume ≥ 72 mL/m2 (HR = 3.51; 95% CI: 1.63 - 7.52; p<0.05) were the only variables that remained as independent predictors of mortality.ConclusionsThe presence of non-sustained ventricular tachycardia on Holter and indexed left atrial volume > 72 mL/m2 are independent predictors of mortality in severe Chagasic heart failure, with cumulative survival probability of only 11% in 7.5 years.

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“…In patients with Chagas disease, most studies and clinicians have focused on the body structure and function components such as cardiac function 12 , 13 , myocardial dilation 14 , and functional capacity 10 . Despite the importance of the presence of depressive symptoms in Chagas disease and the impact of these symptoms on clinical management, few studies have investigated these symptoms.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and determinants of depressive symptoms in patients with Chagas cardiomyopathy and predominantly preserved cardiac function

Silva

Ávila

Oliveira

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: Chagas cardiomyopathy (ChC) is highly stigmatized, and the presence of depressive symptoms may be a common feature. However, its determinants remain unclear. Therefore, the present study aimed to verify the prevalence of depression and the clinical, echocardiographic, functional, and quality of life factors associated with depressive symptoms in patients with ChC and predominantly preserved cardiac function. Methods: Thirty-five patients with ChC (aged 40 to 60 years, 66% men, NYHA I-III) were evaluated by echocardiography, cardiopulmonary exercise testing, 6-minute walk test (6MWT), and Mini-Mental State Examination. Physical activity level was assessed using the Human Activity Profile (HAP) and health-related quality of life was assessed using the Short-Form Health Survey (SF-36). Depressive symptoms were evaluated using the Beck Depression Inventory. A cutoff point greater than 9 was indicative of depression. Results: Depression was detected in 13 patients (37%). In the univariate analysis, female sex, NYHA functional class, body mass index, HAP score, mental summary of SF-36, peak oxygen uptake, and 6MWT distance were associated with depressive symptoms. The final model showed that only the HAP score (B =-0.533; 95% confidence interval [CI]:-0.804 to-0.262) and SF-36 mental summary (B =-0.269; 95% CI:-0.386 to-0.153) remained as independent predictors of depressive symptoms in patients with ChC. Conclusions: Depression was prevalent in patients with ChC and predominantly preserved cardiac function. Physical activity and mental health were independent risk factors for depressive symptoms.

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Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

Cited by 13 publications

References 17 publications

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Prognostic Factors in Severe Chagasic Heart Failure

Prevalence and determinants of depressive symptoms in patients with Chagas cardiomyopathy and predominantly preserved cardiac function

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