Left atrial volume provides independent prognostic value in patients with Chagas cardiomyopathy.
BACKGROUND
Heart failure is a severe clinical manifestation of Chagas disease. Left atrial volume (LAV), a marker of chronically elevated left ventricular (LV) filling pressure, is a predictor of prognosis in patients with heart failure and may be important in the assessment of risk in patients with Chagas disease. The aim of this study was to identify echocardiographic parameters of diastolic function predictors of survival in patients with Chagas cardiomyopathy.


METHODS
A total of 192 patients with Chagas cardiomyopathy (mean age, 48.5 +/- 12.1 years; 37% women) were prospectively enrolled. The end points were death and cardiac transplantation.


RESULTS
Over a mean follow-up period of 33.8 months, LAV normalized for body surface area emerged as an independent predictor of survival (hazard ratio, 1.037 per 1 mL/m(2) change; 95% confidence interval, 1.018-1.056; P < .001), adding incremental prognostic value to clinical factors, LV ejection fraction, and Doppler-derived parameters of diastolic function. Receiver operating characteristic curve analysis identified the best cutoff values for the prediction of end points. LAV > 51 mL/m(2) was associated with significant excess mortality (log-rank, P < .001).


CONCLUSIONS
LAV provides powerful prognostic information incrementally and independently to clinical data and conventional echocardiographic parameters in the prediction of survival. New York Heart Association functional class, LV ejection fraction, right ventricular function, the E/E' ratio, and LAV index can be used to build a risk prediction model, which can be used clinically.
Nunes
Maria Carmo P
MC
ECOCENTER, Hospital Socor, Belo Horizonte, MG, Brazil. mcarmo@waymail.com.br
Barbosa
Marcia M
MM
Ribeiro
Antônio Luiz P
AL
Colosimo
Enrico A
EA
Rocha
Manoel O C
MO
D001938:Brazil / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000000981:diagnostic imaging* / Q000401:mortality*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000706:statistics & numerical data*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate