PROGNOSTIC IMPLICATIONS OF CLINICAL, ELECTROCARDIOGRAPHIC AND HEMODYNAMIC-FINDINGS IN CHRONIC CHAGAS-DISEASE

To evaluate the prognostic importance of 19 clinical, electrocardiogra phic and hemodynamic variables, 556 chronic chagasic patients were sub mitted to an extensive protocol, including left cineventriculogram and Holter monitoring, and followed for up to 15 years. The protagonist r ole of the magnitude of the myocardial compromise in the evolution of chagasic patients is underscored by our results, which indicated the i ndependent prognostic value of an ejection fraction below 0.30 (P < 0. 001), a heart rate higher than 89 beats/min (P < 0.01), grade IV funct ional capacity (P < 0.05), end systolic stress > 120 g/cm(2) (P < 0.05 ), and end diastolic volume index > 200 ml/m(2) (P < 0.05). When only patients with an ejection fraction over 0.29 were considered, variable s with independent prognostic value were: the cardio-thoracic ratio (P < 0.01), functional capacity (P < 0.05) and heart rate (P < 0.05). Su rvival analysis demonstrated that the presence of complex (Lown III, I V) ventricular arrhythmias increased mortality significantly (P < 0.01 ) only in patients with an ejection fraction over 0.29. Therefore, pre servation of myocardial function is the capital measure in the treatme nt of chronic chagasic patients.