Benchimol Barbosa P R
Seção de Arritmia e Eletrofisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rua de Pompeu Loueiro 36/702, 22061-000 Rio de Janeiro, RJ, Brazil.
Braz J Med Biol Res. 2007 Feb;40(2):167-78.
The objective of the present study was to investigate clinical, echocardiographic and electrocardiographic (12-lead resting ECG, 24-h ambulatory ECG monitoring and signal-averaged ECG (SAECG)) parameters in subjects with chronic Chagas' disease in a long-term follow-up as prognostic markers for adverse outcomes. Fifty adult outpatients (34 to 74 years old, 31 females) staged according to Los Andes class I, II or III and complaining of palpitation were enrolled in a longitudinal study. SAECG was analyzed in time and frequency domains and the endpoint was a composite of cardiac death and ventricular tachycardia. During a follow-up of 84.2 +/- 39.0 months, 34.0% of the patients developed adverse outcomes (9 cardiac deaths and 11 episodes of ventricular tachycardia). After optimal dichotomization, in a stepwise multivariate Cox-hazard regression model, apical aneurysm (HR = 3.7; 95% CI = 1.2-1.3; P = 0.02), left ventricular ejection fraction <62% (HR = 4.60; 95% CI = 1.39-15.24; P = 0.01) and incidence of ventricular premature contractions >614 per 24 h (hazard ratio = 6.1; 95% CI = 1.7-22.6; P = 0.006) were independent predictors of the composite endpoint. Although a high frequency content in SAECG demonstrated association with the presence of left ventricular dysfunction and myocardial fibrosis, its predictive value for the composite endpoint was not significant. Apical aneurysms, reduced left ventricular function and a high incidence of ventricular ectopic beats over a 24-h period have a strong predictive value for a composite endpoint of cardiac death and ventricular tachycardia in subjects with chronic Chagas' disease.
本研究的目的是在长期随访中调查慢性恰加斯病患者的临床、超声心动图和心电图（12导联静息心电图、24小时动态心电图监测和信号平均心电图（SAECG））参数，作为不良结局的预后标志物。50名成年门诊患者（年龄34至74岁，女性31名）根据洛斯安第斯分级I、II或III进行分期，且主诉有心悸，纳入一项纵向研究。对SAECG进行时域和频域分析，终点为心源性死亡和室性心动过速的复合终点。在84.2±39.0个月的随访期间，34.0%的患者出现不良结局（9例心源性死亡和11次室性心动过速发作）。在进行最佳二分法后，在逐步多变量Cox风险回归模型中，心尖部动脉瘤（HR = 3.7；95%CI = 1.2 - 1.3；P = 0.02）、左心室射血分数<62%（HR = 4.60；95%CI = 1.39 - 15.24；P = 0.01）以及每24小时室性早搏发生率>614次（风险比 = 6.1；95%CI = 1.7 - 22.6；P = 0.006）是复合终点的独立预测因素。尽管SAECG中的高频成分显示与左心室功能障碍和心肌纤维化的存在相关，但其对复合终点的预测价值并不显著。心尖部动脉瘤、左心室功能降低以及24小时内室性异位搏动的高发生率对慢性恰加斯病患者的心源性死亡和室性心动过速复合终点具有很强的预测价值。
