title: Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction.
abstract: BACKGROUND
  Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis.
  
  
  OBJECTIVE
  To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%.
  
  
  METHODS
  Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation.
  
  
  RESULTS
  In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001).
  
  
  CONCLUSIONS
  The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brasil.
authors.forename: Daniela do Carmo
authors.initials: Ddo C
authors.lastname: Rassi
authors.affiliation: Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Marcelo Luiz Campos
authors.initials: ML
authors.lastname: Vieira
authors.affiliation: Instituto de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Ana Lúcia Martins
authors.initials: AL
authors.lastname: Arruda
authors.affiliation: Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Viviane Tiemi
authors.initials: VT
authors.lastname: Hotta
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brasil.
authors.forename: Rogério Gomes
authors.initials: RG
authors.lastname: Furtado
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brasil.
authors.forename: Danilo Teixeira
authors.initials: DT
authors.lastname: Rassi
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brasil.
authors.forename: Salvador
authors.initials: S
authors.lastname: Rassi
mesh_terms: D000328:Adult; D014355:Chagas Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology