Determinantes prognósticas de mortalidade geral em pacientes com a Doença de Chagas crônica na era contemporânea

Abstract

Chagas disease is considered a serious public health problem in the endemic areas of Latin America. It represents one of the major causes of heart failure and sudden death. The World Health Organization estimates approximately 6 to 7 million people are infected worldwide. Objective: To determine the variables of prediction of general mortality in patients with Chronic Chagas Heart Diseases in the contemporary era. Methods: This was a prospective, longitudinal cohort study. We analyzed medical records of patients diagnosed with Chronic Chagas heart diseases impairing left ventricular systolic dysfunction and without ventricular dysfunction. Patients were followed at the Cardiomyopathy Outpatient Clinic of a School Hospital in the northwest of São Paulo State. Data collection was gathered through the analysis of 339 medical records stored at the Medical and Statistical Archive Service. Cox regression proportional risk model was used to establish independent predictors of mortality. Survival analysis was performed using the Kaplan-Meier method and the comparison of the survival probability between groups was performed using the log test -rank. Results: Of the 339 records of patients with Chronic Chagas Heart diseases, 233 (68.7%) had left ventricular systolic dysfunction and 106 (31.3%) had no Ventricular Dysfunction. Study population mean age was 56.17 ± 14.18 years old. Males were the predominant gender (n=202; 59.6%). At admission, mean systolic blood pressure was 111.08 ± 17.98 mmHg. Diastolic blood pressure was 72.11 ± 11.73 mmHg. The HR was 70.16 ± 13.72 bpm. Segmental dysfunction was observed on the Echocardiogram in 28.3% of the patients. The systolic diameter was 47.34 ± 13.49. LV diastolic was 60.47 ± 10.44. The mean LVEF was 43.88 ± 18.45. The most used medications were Digoxin (52.8%) and Furosemide (62.5%). One hundred and forty-three (42.2%) patients died. Of these, 136 (95.1%) had ventricular dysfunction. Independent predictors of mortality, such as LVSD (RR = 1.075, CI 1.058 to 1.092, p=0.000), HR (RR = 1.019, CI 1.007 to 1.031, p=0.002), and AF (RR=0,600; IC 0.423 to 0.852, p=0.004) were analyzed using multivariate analysis. Total Group presented a median follow-up of 27 months. Chronic Chagas Heart Diseases group presented a mean time of 33.8 ± 30.6 months. Non-dysfunction group with ventricular dysfunction presented a mean time of 45.66 ± 45.1. Conclusion: In this study, 70% of patients with Chronic Chagas Heart Diseases presented mild left ventricular systolic dysfunction. They were followed at a reference center for the treatment of cardiomyopathies. They were also treated with medications recommended in the contemporary era. Heart rate, presence of atrial fibrillation atrial, and left ventricular systolic diameter were considered independent predictors of overall mortality. Because such markers are potentially modifiable, early identification of these variables may alter the clinical course of patients with chronic Chagas heart disease.