Salles et al identified a number of clinical, electrocardiographic and echocardiographic parameters associated with mortality in patients with Chagas’ cardiomyopathy. These can help to identify patients who may benefit from more aggressive management. The authors are from Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro and the Evandro Chagas Hospital in Rio de Janeiro, Brazil.
Patient selection: Chagas’ disease
ECG repolarization parameters associated with increased mortality:
(1) QTc max
(2) QTd (QT dispersion)
(3) QT-VC
(4) TpTed (TpTe interval disperson)
(5) TpTe max
Risk of sudden death (over 120 months = 10 years) based on:
(1) QTd or QTc max
(2) left ventricular systolic function
QTd
LV Systolic Function
Sudden Death
< 60 ms
none or mild
low risk
>= 80 ms
moderate or severe
high risk
QTc max
LV Systolic Function
Sudden Death
< 455 ms^(0.5)
none or mild
low risk
>= 500 ms^(0.5)
moderate or severe
high risk
A patient not classified as low or high risk would be intermediate risk.
Additional factors on univariate analysis associated with Chagas’ disease related mortality:
(1) pathological Q waves
(2) frequent premature contractions (PVCs)
(3) isolated left anterior fascicular block (LAFB)
Clinical findings seen more often in nonsurvivors:
(1) heart failure
(2) syncope
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