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      Noninvasive Predictors of Mortality for Patients with Chagas’ Heart Disease: A Multivariate Stepwise Logistic Regression Study

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          Abstract

          This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas’ heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas’ disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 ± 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 ± 23 mm Hg, diastolic blood pressure 76 ± 11 mm Hg and resting heart rate 77 ± 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na<sup>+</sup> was 140 ± 4 mEq/1, K<sup>+</sup> was 4.34 ± 0.73 mEq/1 and creatinine level 1.34 ± 0.31 mg/l00 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 ± 0.16, left ventricular systolic dimension of 51.23 ± 13.53 mm and left ventricular diastolic dimension of 62.94 ± 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly. By univariate analysis, left ventricular ejection fraction (p = 0.03), left ventricular diastolic dimension (p = 0.03), NYHA class IV (p = 0.0004) and digitalis use (p = 0.04) were found to be associated with mortality. In the multivariate model, however, only left ventricular ejection fraction was retained as an independent predictor of mortality. Actuarial survival was 75% for patients with left ventricular ejection fraction > 0.30, and 40% for patients with left ventricular ejection fraction < 0.30 (p = 0.03). We conclude that patients with Chagas’ heart disease having a left ventricular ejection fraction < 0.30 determined echocardio-graphically are at very high risk of dying.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1994
          1994
          18 November 2008
          : 84
          : 4-5
          : 261-267
          Affiliations
          Heart Institute, Santa Casa Hospital, and Departments of Pathology and Mathematics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
          Article
          176409 Cardiology 1994;84:261–267
          10.1159/000176409
          8187110
          © 1994 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          General Cardiology

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