Enhancing risk assessment in Chagas cardiomyopathy: Electrophysiology study stratified by Rassi score
Ieda Prata Costa1, Neiberg de Alcantara Lima2, Jefferson Luis Vieira3
1Postgraduate Program in Cardiovascular Sciences - Federal University of Ceara, Fortaleza, Brazil.
Insights
The Rassi score effectively stratifies risk in Chagas cardiomyopathy (CCM) patients, correlating with electrophysiology study (EPS) findings. Syncope, reduced ejection fraction, and wall motion abnormalities are key independent predictors of adverse EPS outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Chagas Disease Research
Background:
- Chagas cardiomyopathy (CCM) prevalence is rising globally due to migration.
- Accurate risk stratification is essential for managing CCM's variable clinical progression.
Purpose of the Study:
- To investigate the association between Rassi score progression and electrophysiology study (EPS) changes in CCM patients.
- To identify independent predictors of adverse EPS outcomes in CCM.
Main Methods:
- Prospective observational cohort study of 59 CCM patients.
- Risk stratification using the Rassi score (low, intermediate, high).
- Electrophysiology study (EPS) to assess arrhythmias and conduction intervals; follow-up at 30 days and 6 months.
Main Results:
- 57.6% of patients showed EPS abnormalities, primarily ventricular tachycardia/fibrillation (VT/VF).
- A significant association exists between Rassi score risk classification and EPS changes (OR=1.88, p=0.02).
- Higher Rassi scores correlated with VT presence (p=0.0036); syncope/pre-syncope (OR=2.45, p=0.012) and decreased ejection fraction (p=0.04) were independent predictors.
Conclusions:
- EPS changes in CCM are associated with Rassi score progression, validating its use as a stratification tool.
- Syncope/pre-syncope, reduced LVEF, and wall motion abnormalities independently predict EPS changes within Rassi scores.
Background:
Chagas cardiomyopathy (CCM) is increasingly prevalent in developed countries due to migration from endemic areas. Accurate risk stratification is crucial due to the variable clinical course of CCM.
Objective:
To analyze the association between Rassi score progression and electrophysiology study (EPS) changes in CCM patients.
Methods:
This prospective, observational cohort study involved CCM patients from two tertiary hospitals. Patients were classified as low, intermediate, or high risk based on the Rassi score. Data collected included demographics, clinical history, and diagnostic tests. EPS assessed AH, HH, and HV intervals, and inducibility of ventricular arrhythmias. Follow-ups were at 30 days and six-month intervals, with individualized discussions for cardiac implantable electric devices (CIED) based on EPS results.
Results:
Of 67 screened CCM patients, 59 underwent EPS. The mean Rassi score was 8.7 ± 4.5 points, with 33.8 % low, 38.9 % intermediate, and 27.1 % high risk. EPS abnormalities were found in 57.6 % of patients, mainly VT/VF (52.5 %). Most induced ventricular arrhythmias were monomorphic VT (80.7 %). A significant association was found between Rassi score risk classification and EPS changes (OR = 1.88 95 %CI: 1.15-3.06 p = 0.02). Higher Rassi scores correlated with VT presence on EPS (p = 0.0036). Syncope/pre-syncope had an OR 2.45 95 %CI:1.21-4.94; p = 0.012, independent of Rassi risk. Decreased ejection fraction was linked to EPS changes (p = 0.04).
Conclusion:
EPS changes among CCM was associated with progression of the Rassi score, indicating its utility as a stratification tool. Factors such as the presence of syncope/pre-syncope, decreased LVEF and wall motion abnormalities emerged as independent predictors within Rassi scores for changes in EPS.
