Development of a risk score to predict sudden death in patients with Chaga's heart disease.
BACKGROUND
Sudden death is the most frequent mechanism of death in patients with chronic Chaga's cardiopathy, regardless of the degree of myocardial involvement. We developed a model to predict the risk of sudden death in patients with chronic Chaga's cardiopathy.


METHODS
We retrospectively evaluated 373 patients. The association between the risk factors for chronic Chaga's cardiopathy and sudden death was assessed using Cox proportional-hazards analysis, and a risk score was determined. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the score and Kaplan Meier survival curves, which were stratified according to the score.


RESULTS
During a mean follow-up period of 66±44months, 43 patients experienced sudden death. Four independent predictors were identified, each of which was assigned a number of points proportional to the following regression coefficients: QT-interval dispersion (3 points), syncope (2 points), ventricular extrasystoles (1 point), and severe dysfunction of the left ventricle (1 point). We calculated risk scores for each patient and defined three groups: low risk (0 to 2 points), intermediate (3 to 4 points), and high risk (>5 points). The mortality rates of the three groups were 1.5%, 25%, and 51%, respectively. The C statistic for the prediction score was 0.84, which demonstrated good clinical relevance of the model.


CONCLUSIONS
This simple risk score predicted sudden death in patients with chronic Chaga's heart disease.
Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, Brazil. Electronic address: adrycampos@gmail.com.
Adriana Campos Junqueira
AC
de Souza
Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, Brazil.
Gil
G
Salles
Evandro Chagas National Institute of Infectious Diseases (INI) Oswaldo Cruz Fundation, Rio de Janeiro, Brazil.
Alejandro Marcel
AM
Hasslocher-Moreno
Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, Brazil; Evandro Chagas National Institute of Infectious Diseases (INI) Oswaldo Cruz Fundation, Rio de Janeiro, Brazil.
Andréa Silvestre
AS
de Sousa
Evandro Chagas National Institute of Infectious Diseases (INI) Oswaldo Cruz Fundation, Rio de Janeiro, Brazil.
Pedro Emmanuel
PE
Alvarenga Americano do Brasil
Evandro Chagas National Institute of Infectious Diseases (INI) Oswaldo Cruz Fundation, Rio de Janeiro, Brazil.
Roberto Magalhães
RM
Saraiva
Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, Brazil; Evandro Chagas National Institute of Infectious Diseases (INI) Oswaldo Cruz Fundation, Rio de Janeiro, Brazil.
Sergio Salles
SS
Xavier
D014355:Chagas Disease / Q000150:complications*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment
Chronic Chaga's cardiopathy; Risk score; Sudden death