Published online before print June 30, 2003, doi: 10.1161/01.CIR.0000079174.13444.9C
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;108:305.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Prognostic Value of QT Interval Parameters for Mortality Risk Stratification in Chagas’ Disease
Results of a Long-Term Follow-Up Study
From the Department of Internal Medicine (G.S., S.X., A.S., C.C.), Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, and the Evandro Chagas Hospital (S.X., A.S., A.H.-M.), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Correspondence to Gil Salles, MD, Rua Cróton 72, Jacarepagua, Rio de Janeiro, Brazil, CEP 22750-240. E-mail gilsalles{at}hucff.ufrj.br
Received September 9, 2002; de novo received February 24, 2003; revision received April 24, 2003; accepted April 25, 2003.
Background— QT interval parameters are potential prognostic markers of arrhythmogenicity risk and cardiovascular mortality and have never been evaluated in Chagas’ disease.
Methods and Results— Outpatients (738) in the chronic phase of Chagas’ disease were enrolled in a long-term follow-up study. Maximal heart rate-corrected QT (QTc) and T-wave peak-to-end (TpTe) intervals and QRS, QT, JT, QTapex, and TpTe dispersions and variation coefficients were measured manually and calculated from 12-lead ECGs obtained on admission. Clinical, radiological, and 2-dimensional echocardiographic data were also recorded. Primary end points were all-cause, Chagas’ disease-related, and sudden cardiac mortalities. During a follow-up of 58±39 months, 62 patients died, 54 of Chagas’ disease-related causes and 40 suddenly. Multivariate Cox survival analysis revealed that the QT-interval dispersion (QTd) (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.63; P<0.001, for 10-ms increments) and left ventricular (LV) end-systolic dimension (hazard ratio, 1.36; 95% confidence interval, 1.21 to 1.53; P<0.001, for 5-mm increments) were the strongest independent predictors for all end points. The maximum QTc interval (QTcmax) could substitute for QTd with a worse predictive performance. Other predictors were heart rate, presence of pathological Q waves, frequent premature ventricular contractions (PVCs), and isolated left anterior fascicular block (LAFB) on the ECGs. Kaplan-Meier survival curves demonstrated that a QTd 
65 ms or a QTcmax 465 ms1/2 discriminated the 2 groups with significantly different prognoses.
Conclusions— Electrocardiographic QTd and echocardiographic LV end-systolic dimension were the most important mortality predictors in patients with Chagas’ disease. Heart rate, the presence on ECG of pathological Q waves, frequent PVCs, and isolated LAFB refined the mortality risk stratification.
Key Words: cardiomyopathy • mortality • death, sudden • electrocardiography • echocardiography
This article has been cited by other articles:
 |
|
 |
|
  E. H. Medei, J. H.M. Nascimento, R. C. Pedrosa, L. Barcellos, M. O. Masuda, S. Sicouri, M. V. Elizari, and A. C. Campos de Carvalho Antibodies with beta-adrenergic activity from chronic chagasic patients modulate the QT interval and M cell action potential duration Europace, July 1, 2008; 10(7): 868 - 876. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Roddy, J. Goiri, L. Flevaud, P. P. Palma, S. Morote, N. Lima, L. Villa, F. Torrico, and P. Albajar-Vinas Field Evaluation of a Rapid Immunochromatographic Assay for Detection of Trypanosoma cruzi Infection by Use of Whole Blood J. Clin. Microbiol., June 1, 2008; 46(6): 2022 - 2027. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Bern, S. P. Montgomery, B. L. Herwaldt, A. Rassi Jr, J. A. Marin-Neto, R. O. Dantas, J. H. Maguire, H. Acquatella, C. Morillo, L. V. Kirchhoff, et al. Evaluation and Treatment of Chagas Disease in the United States: A Systematic Review JAMA, November 14, 2007; 298(18): 2171 - 2181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Williams-Blangero, T. Magalhaes, E. Rainwater, J. Blangero, R. Correa-Oliveira, and J. L. VandeBerg Electrocardiographic Characteristics in a Population with High Rates of Seropositivity for Trypanosoma cruzi Infection Am J Trop Med Hyg, September 1, 2007; 77(3): 495 - 499. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rassi Jr, A. Rassi, and S. G. Rassi Predictors of Mortality in Chronic Chagas Disease: A Systematic Review of Observational Studies Circulation, March 6, 2007; 115(9): 1101 - 1108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Acquatella Echocardiography in Chagas Heart Disease Circulation, March 6, 2007; 115(9): 1124 - 1131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rassi Jr., A. Rassi, W. C. Little, S. S. Xavier, S. G. Rassi, A. G. Rassi, G. G. Rassi, A. Hasslocher-Moreno, A. S. Sousa, and M. I. Scanavacca Development and Validation of a Risk Score for Predicting Death in Chagas' Heart Disease N. Engl. J. Med., August 24, 2006; 355(8): 799 - 808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. S. WILSON, A. M. STROSBERG, and K. BARRIO COST-EFFECTIVENESS OF CHAGAS DISEASE INTERVENTIONS IN LATIN AMERICA AND THE CARIBBEAN: MARKOV MODELS Am J Trop Med Hyg, November 1, 2005; 73(5): 901 - 910. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Salles, S. Leocadio, K. Bloch, A. R. Nogueira, and E. Muxfeldt Combined QT Interval and Voltage Criteria Improve Left Ventricular Hypertrophy Detection in Resistant Hypertension Hypertension, November 1, 2005; 46(5): 1207 - 1212. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Esteban, O. Lorenzo, M. Ruperez, Y. Suzuki, S. Mezzano, J. Blanco, M. Kretzler, T. Sugaya, J. Egido, and M. Ruiz-Ortega Angiotensin II, via AT1 and AT2 Receptors and NF-{kappa}B Pathway, Regulates the Inflammatory Response in Unilateral Ureteral Obstruction J. Am. Soc. Nephrol., June 1, 2004; 15(6): 1514 - 1529. [Abstract] [Full Text] [PDF]
|
|