Prognostic indicators of chronic chagasic cardiopathy.
After 104 patients with positive serology for Chagas' disease had been followed for a decade, a selection of 66 patients was made from this number and a total of 25 variables obtained from clinical and paraclinical findings were analyzed, with the purpose of knowing which of these variables may be of help, in time, in determining prognosis. The information was analyzed using the Cox regression model. The patients were classified into groups according to the results in the invasive and noninvasive studies: those with a normal electrocardiogram without heart disease (14 patients) or with early segmental abnormalities of the left ventricle (9 patients); those with an abnormal electrocardiogram and advanced myocardial damage but without signs of congestive heart failure (26 patients); and those with an abnormal electrocardiogram together with congestive heart failure (17 patients). Of these patients, those with electrocardiographic abnormalities correspond to stages of the disease where advanced myocardial damage is proven. There was a 42% mortality during the follow-up of these patients. According to the regression model, the value of the systolic blood pressure is a good predictor of mortality (P = 0.0380) in those with congestive heart failure. When we analyzed jointly the patients with an abnormal electrocardiogram, we found that several variables (systolic blood pressure, the presence of atrial fibrillation, the radiologic cardiothoracic index, and left ventricular end-diastolic volume obtained by the ventriculogram), were negatively correlated with regard to survival. This last model has a chi-square of 11.36 (P = 0.0228). These models allow us to predict the prognosis in this group of patients with Chagas' disease and advanced myocardial damage.(ABSTRACT TRUNCATED AT 250 WORDS)
Espinosa
R A
RA
Cardiology Unit, Dr. Miguel Pérez Carreño Hospital, Social Security Venezuelan Institute, Caracas.
Pericchi
L R
LR
Carrasco
H A
HA
Escalante
A
A
Martínez
O
O
González
R
R
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002598:Chagas Cardiomyopathy / Q000175:diagnosis / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016277:Ventricular Function, Left / Q000502:physiology