Nunes Maria do Carmo P, Rocha Manoel Otávio C, Ribeiro Antônio Luiz P, Colosimo Enrico A, Rezende Renato A, Carmo Guilherme Augusto A, Barbosa Marcia M
ECOCENTER, Hospital Socor, Belo Horizonte, MG, Brazil.
Int J Cardiol. 2008 Jul 21;127(3):372-9. doi: 10.1016/j.ijcard.2007.06.012. Epub 2007 Aug 8.
Right ventricular (RV) involvement is a typical feature of Chagas' disease. In patients with congestive heart failure of other etiologies, RV dysfunction is a strong indicator of poor prognosis. However, the prognostic value of RV dysfunction in patients with Chagas' cardiomyopathy has not been reported. This study sought to investigate the prognostic value of RV dysfunction, apart from other well established risk factors, in patients with Chagas' cardiomyopathy.
The study enrolled 158 patients (99 men; mean age of 48+/-12 years) from a tertiary center for Chagas' disease. Patients were selected if found to have both the diagnosis of Chagas' disease and cardiomyopathy. All patients underwent a comprehensive Doppler echocardiogram and the global RV function was quantitatively assessed using the RV index of myocardial performance (Tei index).
Most of the patients were in NYHA classes I and II (79%). During a mean follow up of 34+/-23 months, 44 patients (28%) died: 24 (55%) patients died of progressive heart failure and 16 (36%) of sudden death. RV Tei index emerged as an independent predictor of survival (hazard ratio 5.75, 95% confidence interval 1.69 to 19.51). Kaplan-Meier survival curves showed a higher cumulative mortality among patients in the highest quartile of RV Tei index, compared with other 3 quartiles (log-rank statistic 21.87, p<0.001). After adjustment for clinical data and LV ejection fraction, RV Tei index in the highest quartile (>0.56) remained a significant predictor of death (hazard ratio 5.29, 95% confidence interval 2.43 to 11.52).
RV function assessed by the Tei index added significant prognostic information, incremental to the NYHA clinical classification and to the standard echocardiographic evaluation of LV systolic function. A simple measure of a Doppler index, which allows analysis of both systolic and diastolic function of the RV, appears to be a useful non-invasive tool for risk stratification in patients with dilated chronic Chagas' cardiomyopathy.
右心室（RV）受累是恰加斯病的典型特征。在其他病因导致的充血性心力衰竭患者中，右心室功能障碍是预后不良的有力指标。然而，右心室功能障碍在恰加斯心肌病患者中的预后价值尚未见报道。本研究旨在探讨除其他已确立的危险因素外，右心室功能障碍在恰加斯心肌病患者中的预后价值。
该研究纳入了一家恰加斯病三级中心的158例患者（99例男性；平均年龄48±12岁）。入选患者需同时确诊恰加斯病和心肌病。所有患者均接受了全面的多普勒超声心动图检查，并使用右心室心肌性能指数（Tei指数）对右心室整体功能进行了定量评估。
大多数患者处于纽约心脏协会（NYHA）心功能I级和II级（79%）。在平均34±23个月的随访期间，44例患者（28%）死亡：24例（55%）死于进行性心力衰竭，16例（36%）死于猝死。右心室Tei指数成为生存的独立预测因素（风险比5.75，95%置信区间1.69至19.51）。Kaplan-Meier生存曲线显示，与其他三个四分位数相比，右心室Tei指数最高四分位数的患者累积死亡率更高（对数秩统计量21.87，p<0.001）。在对临床数据和左心室射血分数进行调整后，最高四分位数（>0.56）的右心室Tei指数仍然是死亡的显著预测因素（风险比5.29，95%置信区间2.43至11.52）。
通过Tei指数评估的右心室功能增加了显著的预后信息，这是对NYHA临床分类和左心室收缩功能的标准超声心动图评估的补充。一种简单的多普勒指数测量方法，可同时分析右心室的收缩和舒张功能，似乎是扩张型慢性恰加斯心肌病患者风险分层的有用非侵入性工具。
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