Manoel Otávio da Costa Rocha UNIVERSIDADE FEDERAL DE MINAS GERAIS - FACULDADE DE MEDICINA PROGRAMA...

Manoel Otávio da Costa Rocha

UNIVERSIDADE FEDERAL DE MINAS GERAIS - FACULDADE DE MEDICINA

PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS DA SAÚDE: INFECTOLOGIA E MEDICINA TROPICAL

Morbidity and prognostic factors in chronic Chagas cardiopathyMedical and Social Relevance

Clinical importance of cardiac form

High morbidity and lethality

Few specific studies concerning its

management

Peculiarities

Low socioeconomic status (Lopes et al., 1995) Advanced stimulus conduction disorders Increased frequency of PVCs and worse

prognosis (Guerrero et al., 1985) Intracardiac nervous system denervation

(Oliveira, 1985) Myocardial fibrosis (Barreto et al., 1997) Ventricular aneurysms (Bestetti & Muccillo, 1997) Thromboembolism (Carod-Artal et al., 2005)

Morbidity and prognostic factors in chronic Chagas cardiopathy

What is the incidence of ischemic cerebrovascular events in patients

with Chagas cardiomyopathy?

What is the effect of the left ventricular ejection fraction on the risk for ischemic cerebrovascular

events?


ThromboembolismMorbidity and prognostic factors in chronic Chagas

cardiopathy

J Neurol Sci. 2009;278:96-101

Thromboembolism

Baseline Characteristics of a Cohort of 213 Patients with Chagas Cardiomyopathy


J Neurol Sci. 2009;278:96-101


cardiopathy

J Neurol Sci. 2009;278:96-101

Thromboembolism

Predictors of ischemic cerebrovascular events in the multivariate analysis


J Neurol Sci. 2009;278:96-101


cardiopathy

J Neurol Sci. 2009;278:96-101

How is the right ventricle affected in Chagas cardiopathy?


Right ventricular involvementMorbidity and prognostic factors in chronic Chagas

cardiopathy

J Am Soc Echocardiogr. 2002;15:1197-201

Right ventricular involvement

Comparison of Doppler tissue imaging in the right ventricle free wall between 12 control participants and 18 chagasic patients with normal echocardiogram

s, Systolic flow velocity wave; IVCTr, regional isovolumic contraction time;e, early expansion velocity wave; a, late expansion velocity wave.




cardiopathy



cardiopathy

Int J Cardiol. 2004;94:79-85


Association between maximal velocity of the tricuspid regurgitation jet and involvement of the right ventricle


Int J Cardiol. 2004;94:79-85

p < 0.00001

Max

Vel

TR

(cm

/s)

Right ventricle

`


Association between left ventricular diastolic diameter and the degree of right ventricular involvement

1: normal2: mildly enlarged3: moderately enlarged 4: severely enlarged


RV

4 3 2 1

LV

d

90

80

70

60

50

n= 43

n= 15

n= 9

n= 7

Int J Cardiol. 2004;94:79-85

p<0.002

(mm

)

What are the prognostic consequences of right ventricular

involvement in chronic Chagas cardiopathy ?



cardiopathy

Int J Cardiol. 2008;127:372-9

Right ventricular involvementBaseline characteristics of the patients and parameters predictors of death in the univariate analysis


Int J Cardiol. 2008;127:372-9


Multivariate analysis of clinical and Doppler echocardiographic variables predicting death in Chagas cardiomyopathy


Int J Cardiol. 2008;127:372-9


cardiopathy

Int J Cardiol. 2008;127:372-9

Does Chagas etiology imply a poorer prognosis when compared to other

cardiomyopathies?


Chagasic vs. Idiopathic

Without known etiology

Ischemic heart disease excluded by angiography

HF: 38Sudden death: 35

Thromboembolism: 4Non-cardiac death: 3

Dilatation with

ventricular dysfunction

Two positive serum test (IIF, IH, ELISA)


Chagasic vs. IdiopathicMorbidity and prognostic factors in chronic Chagas

cardiopathy

Independent predictors of cardiac events in cohort of 169 patients with dilated cardiomyopathy

Chagasic vs. IdiopathicMorbidity and prognostic factors in chronic Chagas

cardiopathy

p=0.001

p<0.001

p<0.001 p<0.001


Chagas cardiomyopathy was associated with worse

survival when compared to IDC, independent of

other clinical factors and echocardiographic

parameters of poor prognosis in HF



p<0.001


Clinical relevance

What can be done?


Multicentric studies

Risk stratification

Identification of high-risk patients

Identification of measures that could modify

cardiac damage, functional heart impairment and

prognosis

Thank [email protected]

Manoel Otávio da Costa Rocha UNIVERSIDADE FEDERAL DE MINAS GERAIS - FACULDADE DE MEDICINA PROGRAMA...

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