[Apical lesion of the left ventricle in clinical evolution of chronic Chagas cardiopathy].

PURPOSE

Study of clinical evolutionary aspect in patients with apical lesion of chronic Chagas' heart disease diagnosed by left cineventriculography.

PATIENTS AND METHODS

55 patients, 32 female, aged 22 to 69 years with epidemiologic data and positive serological tests, all presenting cardiovascular symptoms, 20 in cardiac failure (10 with left ventricular failure and 10 in congestive heart failure). Heart size was normal in 35 patients and 20 showed cardiomegaly on chest X-ray examinations (slight in 8, moderate in 6 and marked in 6), EKG showed premature beats in all patients and conduction defects in 38 instances with a predominance of right bundle branch block associated with left anterior divisional block in 19 cases. The following morphological aspects of the apical lesions were observed: mammillary--23 (41.82%); digital--18 (32.73%) and semilunar--14 (25.45%). In 8 cases (14.54%) intraventricular thrombi were detected and in 10 (18.18%) there were associated dyskinetic areas.

RESULTS

The clinical course of 36 patients (65%) has been followed in the out patient department for 35 to 192 (97.83) months. Seven patients (12.73%) did not return for consultation after having been studied for 22 to 56 (42.83) months, and 12 (22%) died after a follow-up period of 19 to 176 (68.58) months. Detection of 17 thromboembolic episodes occurred in the 14 (25%) patients, 9 pulmonary encephalic and 1 peripheric, very frequent in patients with cardiac failure (11/14-78%). Cardiac pacemakers were implanted in 18 cases due to complete A-V block in 11, to sinus node dysfunction in 6, and to sinus arrest in 1. Among the survivors 29 (80%) maintained a normal heart size. The most frequent cause of death (12) was heart failure in 8, followed by cerebrovascular attacks in 3 and malignancy in 1. The estimated survival in 192 months was of 75.8%, males (74.5%) and females (76.6%). A presence of heart failure however was a limiting factor, with estimates of 96.8% survival in patients without cardiac decompensation, as compared to 36.5% in cases with heart failure.

CONCLUSION

The apical lesion is an additional factor of mortality in Chagas' heart disease after the development of congestive heart failure.