Predictive factors for the progression of chronic Chagas cardiomyopathy in patients without left ventricular dysfunction.
The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC) is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox's univariate model) and multivariate (Cox regression model) analysis. Patients were followed from two to 20 years (mean: 8.2). Their mean age was 44.8 years (20-77). Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01). The predictors for CCC progression in the final regression model were male gender (HR = 2.81), Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02) increased cardiothoracic ratio (HR = 7.87) and time of use of digitalis (HR = 1.41). Patients with multiple predictive factors require stricter follow-up and treatment.
Faculdade de Medicina, Univ. Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Silvana de Araújo
Sde A
Silva
Depto. Medicina Preventiva e Social, Faculdade de Medicina, Univ. Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Eliane Dias
ED
Gontijo
Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, MG, Brasil.
João Carlos Pinto
JC
Dias
Faculdade de Medicina, Univ. Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Camila Gomes de Souza
CG
Andrade
Faculdade de Medicina, Univ. Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Carlos Faria Santos
CF
Amaral
D000328:Adult; D000368:Aged; D002598:Chagas Cardiomyopathy / Q000401:mortality* / Q000503:physiopathology; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D016277:Ventricular Function, Left; D055815:Young Adult