This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rassi, A. Articles by Rassi, S. G. Search for Related Content PubMed PubMed Citation Articles by Rassi, A., Jr Articles by Rassi, S. G. Related Collections Epidemiology

(Circulation. 2007;115:1101-1108.)
© 2007 American Heart Association, Inc.

Heart Disease in Latin America

Predictors of Mortality in Chronic Chagas Disease

A Systematic Review of Observational Studies

Anis Rassi, Jr, MD, PhD; Anis Rassi, MD; Sérgio G. Rassi, MD

From the Division of Cardiology, Anis Rassi Hospital, Goiânia, Brazil.

Correspondence to Dr Anis Rassi Jr, Anis Rassi Hospital, Avenida José Alves 453, Setor Oeste, Goiânia (GO), Brazil. E-mail arassijr{at}terra.com.br or arassijr@arh.com.br

Received April 12, 2006; accepted September 1, 2006.

Background— Chagas disease is a major cause of morbidity and mortality in Latin America. Knowledge of the predictors of prognosis can help clinical decision making by identifying patients’ level of risk.

Methods and Results— We reviewed the published literature on prognostic factors in patients with Chagas disease by performing a PubMed search for articles published in any language between 1985 and February 2006 and hand searches of the reference lists of retrieved articles. Studies were selected if they included patients in the chronic phase of Chagas disease, analyzed a clearly defined outcome (all-cause mortality, sudden cardiac deaths, and/or cardiovascular deaths), and used multivariable regression models of prognosis. From 606 potentially relevant studies, 12 met the inclusion criteria: 8 clinic-based studies including 3928 patients and 4 hospital-based studies including 349 patients. Impaired left ventricular function by echocardiogram or cineventriculogram was found to be the most common and consistent independent predictor of death. New York Heart Association functional class III/IV and cardiomegaly on the chest radiography also were independently associated with higher mortality. More recently, strong evidence was found that nonsustained ventricular tachycardia on 24-hour Holter monitoring indicated an adverse prognosis. The typical ECG abnormalities showed limited additional prognostic value. Other often-mentioned risk factors, advanced age and male sex, showed inconsistent results. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results.

Conclusions— A systematic review of published studies indicates that impaired left ventricular function, New York Heart Association class III/IV, cardiomegaly, and nonsustained ventricular tachycardia indicate a poor prognosis in patients with chronic Chagas disease.

Key Words: cardiomyopathy • Chagas cardiomyopathy • Chagas disease • mortality • prognosis • review, systematic • risk factors

This article has been cited by other articles:

				A Rassi Jr, J C P Dias, J A Marin-Neto, and A Rassi Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas' disease Heart, April 1, 2009; 95(7): 524 - 534. [Abstract] [Full Text] [PDF]

				M. M. Gonzalez, R. A. Berg, V. M. Nadkarni, C. B. Vianna, K. B. Kern, S. Timerman, and J. A. Ramires Left Ventricular Systolic Function and Outcome After In-Hospital Cardiac Arrest Circulation, April 8, 2008; 117(14): 1864 - 1872. [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]