Document Detail


Prognostic value of signal-averaged electrocardiogram in Chagas disease.
MedLine Citation:
PMID:  18266670     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The value of signal-averaged ECG (SAECG) in the risk stratification of Chagas disease (ChD), a potentially lethal illness prevalent in Latin America, remains controversial. The aim of this prospective longitudinal study was to determine the prognostic value of SAECG in ChD, using multivariate models with other established prognostic predictors, and to develop a simple prediction risk score. METHODS: The study enrolled 184 ambulatory ChD patients (107 men; age: 48 +/- 12 years) in sinus rhythm and without other systemic diseases. All patients underwent comprehensive evaluation that included clinical examination, ECG, chest X-ray, 24-hour Holter monitoring, echocardiogram, stress testing, and time domain SAECG. Individual medical therapy was adjusted according to a standardized treatment regimen. The association of potential risk factors obtained by noninvasive evaluation and death was tested by Cox proportional-hazards analysis. RESULTS: During mean follow-up time of 74 +/- 17 months, 13 patients died. Three independent prognostic factors were identified: left ventricular ejection fraction <50% (HR = 5.2, P = 0.048), ventricular tachycardia at either Holter monitoring or stress testing (HR = 9.9, P = 0.036), and prolonged (>150 ms) filtered QRS complex (HR = 4.3, P = 0.035). A prognostic score developed considering the number of risk factors of each patient had an excellent performance in predicting death (c statistic: 0.92). CONCLUSIONS: Prolonged filtered QRS duration obtained by SAECG is an independent predictor of death in ChD. A prediction score including three risk factors, depressed left ventricular ejection fraction, ventricular tachycardia and prolonged filtered QRS complex, has shown to be useful for stratifying risk categories in ChD.
Authors:
Antonio Luiz Pinho Ribeiro; Paulo Sérgio Cavalvanti; Federico Lombardi; Maria do Carmo Pereira Nunes; Márcio Vinícius Lins Barros; Manoel Otávio da Costa Rocha
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-02-04
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  19     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-02     Completed Date:  2008-06-04     Revised Date:  2008-08-21    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  502-9     Citation Subset:  IM    
Affiliation:
Post-graduate Course of Tropical Medicine, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil. tom@hc.ufmg.br
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chagas Cardiomyopathy / diagnosis*,  mortality*
Diagnosis, Computer-Assisted / methods*
Electrocardiography / methods*,  statistics & numerical data*
Female
Humans
Incidence
Italy / epidemiology
Male
Middle Aged
Outcome Assessment (Health Care) / methods*,  statistics & numerical data
Prognosis
Reproducibility of Results
Risk Assessment / methods*
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
Comments/Corrections
Comment In:
J Cardiovasc Electrophysiol. 2008 Jun;19(6):E40; author reply E41   [PMID:  18462337 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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