We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Mortality risk score for patients with Chagas cardiomyopathy and pacemaker.
- Authors
de Lima Peixoto, Giselle; de Siqueira, Sérgio Freitas; Nishioka, Silvana Angelina D'Orio; Pedrosa, Anísio Alexandre Andrade; Teixeira, Ricardo Alkmim; Costa, Roberto; Martinelli Filho, Martino
- Abstract
Background: Prognosis of Chronic Chagasic Cardiomyopathy (CCC) patients depends on functional and clinical factors. Bradyarrhythmia requiring pacemaker is a common complication. Prognosis of these patients is poorly studied, and mortality risk factors are unknown. We aimed to identify predictors of death and to define a risk score for mortality in a large cohort of CCC patients with pacemaker. Methods: It was an observational, unicentric and prospective study. The endpoint was all-cause mortality. Cox regression was used to identify predictors of death and to define a risk score. Bootstrapping method was used to internal score validation. Results: We included 555 patients and after a mean follow-up of 3.7±1.5 years, 100 (18%) deaths occurred. Predictors of death were: right ventricular dysfunction (HR [hazard ratio] 2.24; 95%CI 1.41–3.53; P = 0.001); heart failure class III or IV (HR 2.16; 95% confidence interval [95%CI] 1.16–4.00; P = 0.014); renal disease (HR 2.14; 95%CI 1.24–3.68; P = 0.006); left ventricular end-systolic diameter > 44mm (HR 1.97; 95%CI 1.26–3.05; P = 0.003); atrial fibrillation (HR 1.94; 95%CI 1.25–2.99; P = 0.003) and cardiomegaly on X-ray (HR 1.87; 95%CI 1.10–3.17; P = 0.020). The score identified patients with: low (0–20 points), intermediate (21–30 points) and high risk (>31points). The optimism-corrected C-statistic of the predictive model was 0.751 (95% CI 0.696–0.806). Internal validation with bootstrapping revealed a calibration slope of 0.946 (95% CI 0.920–0.961), reflecting a small degree of over-optimism and C-statistic of 0.746 (95% CI 0.692–0.785). Conclusions: This study identified predictors of mortality in CCC patients with pacemaker defining a simple, validated and specific risk score. Author summary: Chronic Chagas Cardiomyopathy (CCC) is the most important clinical manifestation of chronic Chagas disease. Bradyarrhythmias caused by sinus node disease, atrio and intraventricular block occur in above 50% and requirement of permanent pacing is common. Prognosis of these patients is poorly studied, and mortality risk factors are unknown. Previous studies have identified predictors of death in CCC patients however CCC patients requiring pacemaker were underrepresented. We identified predictors of mortality in CCC patients with pacemaker defining a simple, validated and specific risk score. Predictors of death were: right ventricular dysfunction, heart failure class III or IV, renal disease, left ventricular end-systolic diameter > 44mm, atrial fibrillation and cardiomegaly on X-ray.
- Subjects
DISEASE risk factors; HEART failure; MORTALITY risk factors; RIGHT ventricular dysfunction; CARDIOMYOPATHIES; SINOATRIAL node
- Publication
PLoS Neglected Tropical Diseases, 2024, Vol 18, Issue 5, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0012114