Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction
Daniela do Carmo Rassi1, Marcelo Luiz Campos Vieira2, Ana Lúcia Martins Arruda3
1Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brasil.
Insights
In severe Chagas heart disease, indexed left atrial volume is a key predictor of cardiovascular mortality. This echocardiographic measure helps assess prognosis in patients with reduced ejection fraction.
Area of Science:
- Cardiology
- Echocardiography
- Medical Prognostics
Background:
- Echocardiography is crucial for evaluating heart failure patients.
- Identifying specific echocardiographic markers in severe Chagas heart disease can guide treatment and prognosis.
- Severe Chagas heart disease significantly impacts cardiac function and patient outcomes.
Purpose of the Study:
- To correlate echocardiographic parameters with cardiovascular mortality in patients with ejection fraction below 35%.
- To identify independent predictors of mortality in severe Chagas heart disease.
Main Methods:
- Retrospective analysis of prospectively collected echocardiographic data from 60 Chagas heart disease patients.
- Key parameters analyzed included left atrial volume, ejection fraction, and E/Em ratio.
- Multivariate analysis was used to determine independent predictors of cardiovascular mortality.
Main Results:
- Indexed left atrial volume emerged as the sole independent predictor of mortality.
- Values of indexed left atrial volume greater than 70.71 mL/m2 were significantly associated with increased mortality.
- Ejection fraction and E/Em ratio were not independent predictors in this cohort.
Conclusions:
- Indexed left atrial volume is the only independent predictor of mortality in Chagasic patients with severe systolic dysfunction.
- This finding highlights the prognostic value of indexed left atrial volume in this specific patient population.
- Echocardiographic assessment of left atrial volume is vital for risk stratification in severe Chagas heart disease.
Background:
Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis.
Objective:
To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%.
Methods:
Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation.
Results:
In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001).
Conclusion:
The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.
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