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Predictors of unfavourable prognosis in chronic Chagas' disease
1Faculdade de Medicina Barão de Mauá, Ribeirão Preto City, and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto City, Brazil. lzvanaz@rge.fmrp.usp.br
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Clinical factors like systolic blood pressure and male sex predict cardiac issues in Chagas
Area of Science:
- Cardiology
- Infectious Diseases
- Echocardiography
Background:
- Chronic Chagas' disease poses significant risks for cardiac complications, including left ventricular dysfunction, dilatation, and apical aneurysm.
- These echocardiographic findings are independent predictors of mortality and sudden cardiac death in affected patients.
- Identifying clinical predictors is crucial for early risk stratification and management of Chagas' disease patients.
Purpose of the Study:
- To identify clinical predictors of left ventricular dysfunction, dilatation, and apical aneurysm in patients with chronic Chagas' disease.
- To assess the utility of these predictors in identifying individuals at higher risk of adverse cardiac events.
Main Methods:
- Seventy-four patients with confirmed Chagas' disease underwent echocardiography.
- Stepwise logistic regression analysis was used to identify independent clinical predictors.
- Receiver-operating characteristic (ROC) curves were employed to determine optimal predictive thresholds.
Main Results:
- Systolic blood pressure (SBP) and male sex independently predicted left ventricular dilatation.
- An SBP of 120 mmHg, alone or in combination with male sex, showed predictive value for dilatation.
- SBP and New York Heart Association (NYHA) functional class independently predicted left ventricular systolic dysfunction.
- An SBP of 120 mmHg and NYHA class 2 were identified as predictors for systolic dysfunction.
- Myocardial necrosis on resting ECG predicted apical aneurysm, though with low sensitivity.
Conclusions:
- Clinical examination findings, including SBP and NYHA class, can independently predict echocardiographic markers of cardiac mortality in Chagas' disease.
- These clinical predictors may aid in the screening and identification of high-risk patients.
- Early identification of at-risk individuals can facilitate timely interventions to prevent adverse cardiac outcomes.
Abstract:
The aim of this study was to detect clinical predictors of left ventricular dysfunction, left ventricular dilatation and apical aneurysm on echocardiography, all known as independent predictors of lethal outcome for patients with chronic Chagas' disease. Seventy-four patients with a positive complement-fixation test for Chagas' disease participated; 44 (59%) had left ventricular dysfunction, 41 (55%) left ventricular dilatation and 15 (20%) apical aneurysm. A stepwise logistic regression analysis showed that systolic blood pressure (P < 0.001) and male sex (P < 0.001) were independent predictors of left ventricular dilatation on echocardiography. A receiver-operating characteristic curve provided a systolic blood pressure of 120 mmHg with a sensitivity of 70% and a specificity of 63% to predict left ventricular dilatation. The combination of male sex and systolic blood pressure of 120 mmHg had a sensitivity of 56% and a specificity of 91% to predict left ventricular dilatation. In a separate stepwise logistic regression analysis, left ventricular systolic dysfunction was independently predicted by systolic blood pressure (P = 0.006) and New York Heart Association functional class (P = 0.01). Receiver-operating curves provided a blood pressure of 120 mmHg with a sensitivity of 72% and a specificity of 59% to predict left ventricular dysfunction, whereas a New York Heart Association functional score of 2 predicted left ventricular systolic dysfunction with a sensitivity of 78% and a specificity of 50%. The combination of New York Heart Association functional class and a systolic blood pressure of 120 mmHg predicted left ventricular dysfunction with a sensitivity of 59% and a specificity of 77%. The apical aneurysm was independently predicted by myocardial necrosis on the resting ECG, but only with a sensitivity of 20%. Hence, echocardiographic markers of cardiac mortality and sudden cardiac death in Chagas' disease can be independently predicted by clinical examination. This may be useful for screening high-risk chagasic patients.
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