Viotti R J, Vigliano C, Laucella S, Lococo B, Petti M, Bertocchi G, Ruiz Vera B, Armenti H
Cardiology Department, Hospital Eva Perón, San Martin, Buenos Aires, Argentina.
Heart. 2004 Jun;90(6):655-60. doi: 10.1136/hrt.2003.018960.
To establish the usefulness of echocardiography for the clinical classification of patients with Chagas disease and to determine the predictors of mortality and clinical events.
849 patients with chronic Chagas disease with a mean follow up of 9.9 years were studied. On admission, ECG, chest radiograph, and two dimensional echocardiogram were obtained from all patients. Clinical events were defined as new ECG abnormalities, change in clinical status resulting in transfer to another group, and death. Morphologically characterised segmental lesions were also seen in 12 patients on a second harmonic echocardiogram with intravenous contrast agent. Univariate and multivariate analysis for clinical events and mortality were performed.
Community of San Martín, Buenos Aires, Argentina.
Change in clinical group (68 of 833 survivors v 15 of 16 who died, p < 0.001), left ventricular systolic dimension (mean (SD) 3.06 (0.72) cm v 4.71 (0.90) cm, p < 0.0001), and ejection fraction (mean (SD) 0.67 (0.11)% v 0.42 (0.17)%, p < 0.0001) were found to be the only predictors of mortality. ECG abnormalities related to the disease (in 220 of 699 patients with no clinical event v 98 of 150 patients with a clinical event, p < 0.0001), left ventricular diastolic dimension (mean (SD) 4.88 (0.54) cm v 5.44 (0.83) cm, p < 0.0001), left ventricular systolic dimension (mean (SD) 2.98 (0.62) cm v 3.64 (1.03) cm, p < 0.0001), and ejection fraction (mean (SD) 0.68 (0.10)% v 0.60 (0.16)%, p < 0.0001) were predictors of clinical events. Segmental lesions were observed in 211 of 849 patients (25%). Segmental lesions were seen in 66 (13%) and systolic dysfunction was seen in four of 505 (0.8%) patients with normal ECG. Significant differences were found between the groups of patients (group 0: reactive serology and normal ECG and chest radiography without cardiac enlargement and no signs of heart failure; group 1: reactive serology and abnormal ECG and chest radiography without cardiac enlargement; group 2: reactive serology and abnormal ECG and chest radiography with cardiac enlargement and no signs of heart failure).
Echocardiography was useful both to characterise and to determine the prognosis of patients with chronic Chagas disease without heart failure.
确定超声心动图在恰加斯病患者临床分类中的作用,并确定死亡率和临床事件的预测因素。
对849例慢性恰加斯病患者进行研究,平均随访9.9年。所有患者入院时均进行了心电图、胸部X光片和二维超声心动图检查。临床事件定义为新的心电图异常、临床状态改变导致转至另一组以及死亡。在12例患者的二次谐波超声心动图检查中,静脉注射造影剂后也发现了形态学特征性节段性病变。对临床事件和死亡率进行了单因素和多因素分析。
阿根廷布宜诺斯艾利斯圣马丁社区。
临床分组改变(833例幸存者中有68例,16例死亡者中有15例,p<0.001)、左心室收缩径(均值(标准差)3.06(0.72)cm对4.71(0.90)cm,p<0.0001)和射血分数(均值(标准差)0.67(0.11)%对0.42(0.17)%,p<0.0001)被发现是仅有的死亡率预测因素。与疾病相关的心电图异常(699例无临床事件患者中有220例,150例有临床事件患者中有98例,p<0.0001)、左心室舒张径(均值(标准差)4.88(0.54)cm对5.44(0.83)cm,p<0.0001)、左心室收缩径(均值(标准差)2.98(0.62)cm对3.64(1.03)cm,p<0.0001)和射血分数(均值(标准差)0.68(0.10)%对0.60(0.16)%,p<0.0001)是临床事件的预测因素。849例患者中有211例(25%)观察到节段性病变。505例心电图正常的患者中有66例(13%)出现节段性病变,4例(0.8%)出现收缩功能障碍。不同患者组之间存在显著差异(0组:血清学反应阳性且心电图和胸部X光片正常,无心脏扩大且无心力衰竭体征;1组:血清学反应阳性且心电图和胸部X光片异常,无心脏扩大;2组:血清学反应阳性且心电图和胸部X光片异常,有心脏扩大且无心力衰竭体征)。
超声心动图对于无心力衰竭的慢性恰加斯病患者的特征描述和预后判断均有帮助。