Repolarization Parameters Are Associated With Mortality In Chagas Disease Patients In The United States

• Main Authors: Jason Bradfield, MD, Brandon Woodbury, MD, Mahmoud Traina, MD, Salvador Hernandez, MD, Robin Wachsner, MD, Kalyanam Shivkumar, MD, PhD, Sheba Meymandi, MD
• Format: Article
• Language: English
• Published: Elsevier 2014-07-01
• Series: Indian Pacing and Electrophysiology Journal
• Subjects: Chagas Disease; Repolarization Parameters; Mortality
• Online Access: http://www.sciencedirect.com/science/article/pii/S0972629216307732

Objective: The goal of this study was to examine the association between ECG repolarization parameters and mortality in Chagas disease (CD) patients living in the United States. Methods: CD patients with cardiomyopathy (CM) and bundle branch block (BBB) or BBB alone were compared to age- and sex-matched controls. QT interval, QT dispersion (QTd), T wave peak to T wave end duration (Tp-Te) and T wave peak to T wave end dispersion ((Tp-Te)d) were measured. Presence of fractionated QRS (fQRS) was also assessed. The main outcome measure was the association between ECG parameters and mortality or need for cardiac transplant. Results: A total of 18 CM and 13 BBB CD patients were studied with 97% originating from Mexico or Central America. QTd (60.0±15.0 ms vs 43.5±9.8 ms, P=0.0002), Tp-Te (102.6±29.3 ms vs 77.1±11.0 ms, P=0.0002) and (Tp-Te)d (39.5±9.4 ms vs 22.7±7.6 ms, P<0.0001) were prolonged in CD CM patients compared to CM controls. Chagas CM patients had more fQRS then controls (84.2±0.10% vs 33.3±0.11%, p=0.0005). QTd (59.9±15.0 ms vs 29.5±6.9 ms, P=0.0001) and (Tp-Te)d (40.0±15.9 ms vs 18.5±5.4 ms, p<0.0001) were longer in the CD BBB group compared to BBB controls. Univariate analysis showed QTd (56.9±15.0 ms vs 46.5±17.3 ms, p=0.0412) and (Tp-Te)d (36.8±13.5 ms vs 28.5±13.3 ms, p=0.0395) were associated with death and/or need for cardiac transplant. Conclusion: CD patients with CM and BBB or BBB alone have increased evidence of dispersion of repolarization compared to controls. QTd and (Tp-Te)d were associated with increased mortality and/or need for transplant.