Echocardiographic and Clinical Predictors of Mortality in Chronic Chagas' Disease

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Abstract
Background:In a prospective epidemiological study of chronic Chagas' disease, several clinical and echocardiographic variables were analyzed as predictors of mortality. Methods: Among 960 subjects seropositive for Chagas' disease who were examined between June 1981 and June 1992, 283 had echocardiograms.Results:During a mean follow‐up period of 48.3 ± 36.4 months (range, 1–156 months), 108 subjects died. Echocardiographic end‐diastolic and ‐systolic left ventricular internal dimensions, fractional shortening, radius‐to‐thickness ratio, left ventricular mass, mitral E‐point septal separation, and 17 other nonechocardiographic variables were predictors of death on univariate analysis (P < 0.001 for each). On stepwise multiple regression analysis of 215 subjects, significant risk covariates in a Cox model analysis were clinical group (P < 0.0001), M‐mode echocardiographic E‐point septal separation of 22 mm (P = 0.003), presence of first‐ or second‐degree heart block (P = 0.003), chest radiologic cardiothoracic ratio ≤ 0.55 (P = 0.012), presence of electrocar‐diographic ST segment elevation on precordial leads (P = 0.014), age ≤ 56 years (P = 0.028), and presence of right bundle‐branch block (P = 0.045). Patients with an apical aneurysm on two‐dimensional echocardiography had an increased mortality (Chi‐square = 11.5, P < 0.001).Conclusions:Echocardiography is a valuable tool to assess the risk of death in prospective studies on chronic Chagas' heart disease.