Pereira Francisca Tatiana Moreira, Rocha Eduardo Arrais, Monteiro Marcelo de Paula Martins, Neto Almino Cavalcante Rocha, Daher Elisabeth de Francesco, Sobrinho Carlos Roberto Martins Rodrigues, Pires Neto Roberto da Justa
Department of Community Health, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Pacemaker and Electrophisiology, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Pacing Clin Electrophysiol. 2014 Jun;37(6):751-6. doi: 10.1111/pace.12342. Epub 2014 Jan 27.
BACKGROUND/OBJECTIVES: Chronic Chagas heart disease (ChHD) is associated with ventricular tachyarrhythmias and an increased risk of sudden cardiac death. Little is known about the effectiveness of implantable cardioverter-defibrillator (ICD) therapy in this population. The objective of this study was to evaluate the efficacy of ICD in patients with ChHD and to identify predictors of mortality and appropriate ICD shocks.
The cohort study included 65 patients with ChHD and ICD for primary and secondary prevention of sudden death. The Cox model was applied to evaluate the predictors of mortality, and survival was assessed by Kaplan-Meier analysis.
The median age was 56 ± 11.9 years. The median follow-up was 40 ± 26.8 months. Among the patients 23 (36.5%) had appropriate shocks. A total of 13 (20%) patients died (6.1% of annual mortality rate), and there was no sudden death. In univariate Cox model, functional class IV (hazard ratio [HR] = 1.99; 95% confidence interval [CI], 1.05-3.76; P = 0.034), primary prevention (HR = 0.29; 95% CI, 0.09-0.99; P = 0.048), lower education (HR = 2.51; 95% CI, 1.05-5.99; P = 0.038), and ejection fraction <30% (HR = 2.80; 95% CI, 1.09-7.18; P = 0.032) were predictors of worse prognosis (death). In the multivariate Cox model, an ejection fraction <30% and the low education remained predictors of poor prognosis. Predictors of appropriate shocks were not found.
The ICD was effective for the prevention of sudden cardiac death in patients with chronic ChHD. An ejection fraction <30% and low education were predictors of poor prognosis.
背景/目的：慢性恰加斯心脏病（ChHD）与室性快速性心律失常及心脏性猝死风险增加相关。关于植入式心脏复律除颤器（ICD）治疗该人群的有效性知之甚少。本研究的目的是评估ICD对ChHD患者的疗效，并确定死亡率和ICD恰当电击的预测因素。
该队列研究纳入了65例因心脏性猝死的一级和二级预防而植入ICD的ChHD患者。应用Cox模型评估死亡率的预测因素，并通过Kaplan-Meier分析评估生存率。
中位年龄为56±11.9岁。中位随访时间为40±26.8个月。在患者中，23例（36.5%）接受了恰当电击。共有13例（20%）患者死亡（年死亡率为6.1%），且无心脏性猝死。在单变量Cox模型中，心功能IV级（风险比[HR]=1.99；95%置信区间[CI]，1.05 - 3.76；P = 0.034）、一级预防（HR = 0.29；95% CI，0.09 - 0.99；P = 0.048）、低教育水平（HR = 2.51；95% CI，1.05 - 5.99；P = 0.038）和射血分数<30%（HR = 2.80；95% CI，1.09 - 7.18；P = 0.032）是预后较差（死亡）的预测因素。在多变量Cox模型中，射血分数<30%和低教育水平仍是预后不良的预测因素。未发现恰当电击的预测因素。
ICD对预防慢性ChHD患者的心脏性猝死有效。射血分数<30%和低教育水平是预后不良的预测因素。
