[Clinical predictors of chronic chagasic myocarditis progression].
OBJECTIVE
Previous prognostic studies of Chagas' disease have focused on mortality associated with end-stage cardiopathy (i.e., heart failure). Our aim was to identify indicators of progression in early-stage Chagas' heart disease.


METHODS
The study included 856 patients with 3 positive anti-Trypanosoma cruzi test results. Those with heart failure were excluded. Patients were divided into 3 clinical groups: those without heart disease (Group I); those with heart disease but without left ventricular enlargement (Group II); and those with left ventricular enlargement but without heart failure (Group III). The endpoint was progression to a more severe clinical stage or death due to cardiovascular disease. A Cox regression model was used to derive a clinical risk score from clinical, electrocardiographic and echocardiographic variables.


RESULTS
At study entry, the patients' mean age was 43.7 years. They were followed up for a mean of 8 years. The following were predictors of heart disease progression: age at entry (HR=1.05; 95% CI, 1.02-1.07; P<.001), left ventricular systolic diameter (HR=1.06; 95% CI, 1.04-1.09; P<.001), intraventricular conduction abnormalities (HR=1.85; 95% CI, 1.02-3.36; P=.04), and sustained ventricular tachycardia (HR=3.97; 95% CI, 1.65-9.58; P=.002). Treatment with benznidazole reduced the risk of progression (HR=0.40; 95% CI, 0.23-0.72; P=.002). The devised clinical risk score was effective in stratifying the likelihood of cardiopathy progression.


CONCLUSIONS
Specific clinical indicators and a derived clinical risk score can be used to predict the progression of chronic chagasic myocarditis in patients without heart failure.
Viotti
Rodolfo
R
Servicio de Cardiología, Hospital Eva Perón, San Martín, Buenos Aires, Argentina. peron@millicom.com.ar
Vigliano
Carlos
C
Lococo
Bruno
B
Petti
Marcos
M
Bertocchi
Graciela
G
Alvarez
María G
MG
Armenti
Alejandro
A
D000328:Adult; D002598:Chagas Cardiomyopathy / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009205:Myocarditis / Q000209:etiology*; D009593:Nitroimidazoles / Q000627:therapeutic use; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014344:Trypanocidal Agents / Q000627:therapeutic use
D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole