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Predictors of Mortality in Patients with Chagas’ Cardiomyopathy and Ventricular Tachycardia Not Treated with Implantable Cardioverter‐Defibrillators
Author(s) -
SARABANDA ALVARO VALENTIM LIMA,
MARINNETO JOSÉ ANTÔNIO
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2010.02896.x
Subject(s) - medicine , ejection fraction , cardiology , ventricular tachycardia , implantable cardioverter defibrillator , hazard ratio , heart failure , cardiomyopathy , confidence interval
Background: The natural history of the arrhythmogenic form of Chagas’ heart disease is not fully understood.Methods: We assessed the outcome of 56 patients with Chagas’ cardiomyopathy ([31 men]; mean age of 55 years; mean left ventricular ejection fraction [LVEF] 42%) presenting with either sustained ventricular tachycardia (VT) or nonsustained VT (NSVT), before therapy with implantable cardioverter‐defibrillator was available at our center.Results: Over a mean follow‐up of 38 ± 16 months (range, 1–61 months), 16 patients (29%) died, 11 due to sudden cardiac death (SCD), and five from progressive heart failure. Survivors and nonsurvivors had comparable baseline characteristics, except for a lower LVEF (46 ± 7% vs 31 ± 9%, P < 0.001) and a higher New York Heart Association class (P = 0.003) in those who died during follow‐up. Receiver‐operator characteristic curve analysis showed that an LVEF cutoff value of 38% had the best accuracy for predicting all‐cause mortality and an LVEF cutoff value of 40% had the best accuracy for prediction of SCD. Using the multivariate Cox regression analysis, LVEF < 40% was the only predictor of all‐cause mortality (hazard ratio [HR] 12.22, 95% confidence interval [CI] 3.46–43.17, P = 0.0001) and SCD (HR 6.58, 95% CI 1.74–24.88, P = 0.005).Conclusions: Patients with Chagas’ cardiomyopathy presenting with either sustained VT or NSVT run a major risk for mortality when had concomitant severe or even moderate LV systolic dysfunction. (PACE 2011; 54–62)