PREDICTIVE FACTORS FOR THE PROGRESSION OF CHRONIC CHAGAS CARDIOMYOPATHY IN PATIENTS WITHOUT LEFT VENTRICULAR DYSFUNCTION

• Main Authors: Silvana de Araújo SILVA, Eliane Dias GONTIJO, João Carlos Pinto DIAS, Camila Gomes de Souza ANDRADE, Carlos Faria Santos AMARAL
• Format: Article
• Language: English
• Published: Universidade de São Paulo 2015-04-01
• Series: Revista do Instituto de Medicina Tropical de São Paulo
• Subjects: Chagas cardiomyopathy; Clinical progression; Prognosis; Cohort studies
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652015000200153&lng=en&tlng=en

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.