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Prognostic implications of clinical, electrocardiographic and hemodynamic findings in chronic Chagas' disease
H A Carrasco1, H Parada, L Guerrero
1Centro de Investigaciones Cardiovasculares Dr Abdel Fuenmayor, Universidad de Los Andes, Mérida, Venezuela.
Insights
Myocardial compromise significantly impacts chronic Chagas disease progression. Key indicators like ejection fraction and heart rate predict outcomes, highlighting the importance of preserving heart function.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Chagas disease, caused by *Trypanosoma cruzi*, leads to chronic cardiac complications.
- Prognostic factors in chronic Chagasic cardiomyopathy require further elucidation.
- Understanding disease progression is crucial for effective patient management.
Purpose of the Study:
- To identify clinical, electrocardiographic, and hemodynamic predictors of prognosis in chronic Chagasic patients.
- To assess the role of myocardial function in disease evolution.
- To guide therapeutic strategies for managing Chagasic cardiomyopathy.
Main Methods:
- A cohort of 556 chronic Chagasic patients was followed for up to 15 years.
- Comprehensive evaluation included left cineventriculography and Holter monitoring.
- Analysis of 19 clinical, electrocardiographic, and hemodynamic variables.
Main Results:
- Ejection fraction < 0.30, heart rate > 89 bpm, and high end-systolic stress were independent predictors of poor prognosis.
- In patients with preserved ejection fraction (>0.29), cardio-thoracic ratio and functional capacity were significant prognostic factors.
- Complex ventricular arrhythmias increased mortality only in patients with preserved ejection fraction.
Conclusions:
- The magnitude of myocardial compromise is a critical determinant of Chagas disease progression.
- Preserving myocardial function is paramount in the treatment of chronic Chagasic patients.
- Specific prognostic markers vary based on the degree of left ventricular systolic dysfunction.
Abstract:
To evaluate the prognostic importance of 19 clinical, electrocardiographic and hemodynamic variables, 556 chronic chagasic patients were submitted to an extensive protocol, including left cineventriculogram and Holter monitoring, and followed for up to 15 years. The protagonist role of the magnitude of the myocardial compromise in the evolution of chagasic patients is underscored by our results, which indicated the independent prognostic value of an ejection fraction below 0.30 (P < 0.001), a heart rate higher than 89 beats/min (P < 0.01), grade IV functional capacity (P < 0.05), end systolic stress > 120 g/cm2 (P < 0.05), and end diastolic volume index > 200 ml/m2 (P < 0.05). When only patients with an ejection fraction over 0.29 were considered, variables with independent prognostic value were: the cardio-thoracic ratio (P < 0.01), functional capacity (P < 0.05) and heart rate (P < 0.05). Survival analysis demonstrated that the presence of complex (Lown III, IV) ventricular arrhythmias increased mortality significantly (P < 0.01) only in patients with an ejection fraction over 0.29. Therefore, preservation of myocardial function is the capital measure in the treatment of chronic chagasic patients.