ECHOCARDIOGRAPHIC AND CLINICAL PREDICTORS OF MORTALITY IN CHRONIC CHAGAS-DISEASE

Background: In, a prospective epidemiological study of chronic Chagas' disease, several clinical and echocardiographic variables were analyz ed as predictors of mortality. Methods: Among 960 subjects seropositiv e for Chagas' disease who were examined between June 1981 and June 199 2, 283 had echocardiograms. Results: During a mean follow-up period of 48.3 +/- 36.4 months (range, 1-156 months), 108 subjects died. Echoca rdiographic end-diastolic and -systolic left ventricular internal dime nsions, fractional shortening, radius-to-thickness ratio, left ventric ular mass, mitral E-point septal separation, and 17 other nonechocardi ographic variables were predictors of death on univariate analysis (P < 0.001 for each). On stepwise multiple regression analysis of 215 sub jects, significant risk covariates in a Cox model analysis were clinic al group (P < 0.0001), M-mode echocardiographic E-point septal separat ion of 22 mm (P = 0.003), presence of first-or second-degree heart blo ck (P = 0.003), chest radiologic cardiothoracic ratio greater than or equal to 0.55 (P = 0.012), presence of electrocardiographic ST segment elevation on precordial leads (P = 0.014), age greater than or equal to 56 years (P = 0.028), and presence of right bundle-branch block (P = 0.045). Patients with an, epical aneurysm on two-dimensional echocar diography had an increased mortality (Chi-square = 11.5 P < 0.001). Co nclusions: Echocardiography is a valuable tool to assess the risk of d eath in prospective studies on, chronic Chagas' heart disease.