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Noninvasive predictors of mortality for patients with Chagas' heart disease: a multivariate stepwise logistic
R B Bestetti1, C M Dalbo, O C Freitas
1Heart Institute, Santa Casa Hospital, Ribeirão Preto, Brazil.
Insights
This study identified noninvasive predictors of mortality in Chagas' heart disease patients. Key factors like NYHA class and ECG abnormalities can help predict patient survival and guide treatment strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Chagas' heart disease poses a significant mortality risk.
- Identifying noninvasive predictors is crucial for patient management.
- Current prognostic tools for Chagas' heart disease require refinement.
Purpose of the Study:
- To identify noninvasive predictors of mortality in patients with Chagas' heart disease.
- To utilize multivariate logistic regression for prognostic factor analysis.
- To improve risk stratification for Chagas' heart disease.
Main Methods:
- Prospective investigation of 56 patients with Chagas' disease.
- Follow-up over a 2-year period (April 1990 - April 1992).
- Multivariate stepwise logistic regression analysis.
Main Results:
- 16 (28%) patients died during the study period.
- 11 of the deaths were sudden.
- Analysis identified specific clinical and electrocardiographic factors associated with mortality.
Conclusions:
- Noninvasive predictors for Chagas' heart disease mortality were identified.
- These predictors can aid in risk stratification and clinical decision-making.
- Further research is warranted to validate these findings in larger cohorts.
Abstract:
This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas' heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas' disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 +/- 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 +/- 23 mm Hg, diastolic blood pressure 76 +/- 11 mm Hg and resting heart rate 77 +/- 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na+ was 140 +/- 4 mEq/l, K+ was 4.34 +/- 0.73 mEq/l and creatinine level 1.34 +/- 0.31 mg/100 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 +/- 0.16, left ventricular systolic dimension of 51.23 +/- 13.53 mm and left ventricular diastolic dimension of 62.94 +/- 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly.(ABSTRACT TRUNCATED AT 250 WORDS)