Determinantes prognósticos de pacientes portadores de insuficiência cardíaca crônica secundária à cardiomiopatia da doença de chagas na lista de espera para um transplante cardíaco

Abstract

No previous study has addressed the question of prognostic determinants for patients with Chagas’ cardiomyopathy at the terminal stage listed for heart transplantation. Casuistic and Method: All patients listed for heart transplantation at our institution from August, 2000 to March, 2005 were considered for the study. Patients removed from the waiting list for clinical status improvement were excluded from the investigation. Patients were followed until death, cardiac transplantation or the end of the study period. Cardiac transplant recipients were censored at the time of transplantation. No patient was lost to follow up. A Cox regression hazards model was used to establish independent predictors of all-cause mortality. Variables previously demonstrated to predict mortality in either Chagas or non-Chagas’ disease heart failure were entered the univariate analysis. Separate analyses were performed for Chagas and non-Chagas’ disease patients. Results: Median follow up was 32 (15,121) days in Chagas disease and 79 (14,151) days in non-Chagas’ disease patients. In Chagas disease patients, the hemodynamic instability (p=0.01; hazard ratio=0,077, 95% confidence interval, 0.01 to 0.58) as well as the transpulmonary gradient (p=0.02; hazard ratio=1.15, 95% confidence interval, 1.02 to 1.30) were retained as independent predictors of all-cause mortality. Serum sodium levels (p=0.002; hazard ratio=0.81; 95% confidence interval, 0.71 to 0.93) was independent predictor of all-cause mortality for non-Chagas’ disease patients. Conclusion: The hemodynamic instability and transpulmonary gradient were independent predictors of all-cause mortality for Chagas’ disease patients listed for heart transplantation. A larger, prospective cohort study is needed to validate our findings.