Danton Machado da Cunha, Mauro Felippe Felix Mediano, Lorena dos Santos Marreto Rimolo, Andréa Rodrigues da Costa, Danilo Bento Diogo, Luiz Henrique Conde Sangenis, Henrique Horta Veloso, Marcelo Teixeira de Holanda, Alejandro Marcel Hasslocher-Moreno, Ademir Batista da Cunha, Roberto Magalhães Saraiva
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引用次数: 0
Abstract
Purpose
Patients with chronic Chagas cardiomyopathy (CCC) have a high mortality due to heart failure (HF). The aim of this study was to investigate clinical and echocardiographic predictors of incident HF in patients with CCC.
Methods
Single-center retrospective longitudinal observational study which included 176 adult patients (59.1% women; 53.9 ± 10 years old; mean left ventricular [LV] ejection fraction 62% ± 10%) at an early stage of CCC (electrocardiogram and/or wall motion changes but no HF). The primary outcome was incident HF. The association between studied parameters with incident HF was performed by competing-risk survival regression models using the Fine and Gray method.
Results
After a mean follow-up of 8.8 ± 3.6 years, 42 patients progressed to HF (27.04 cases/1000 patient-years). A model 0 adjusted for clinical and 2D-Doppler echocardiographic parameters and for all-cause mortality revealed diabetes mellitus (HR 4.91, 95% CI 1.67–14.4, p = 0.004), LV ejection fraction (HR 0.96, 95% CI 0.93–0.99, p = 0.022), and E’ velocity (HR 0.79, 95% CI 0.67–0.95, p = 0.01) as independently associated with incident HF. The addition of strain-derived parameters to model 0 revealed that LV global circumferential strain (HR 0.83, 95% CI 0.78–0.89, p < 0.001) and left atrial booster contraction strain (HR 1.14, 95% CI 1.02–1.28, p = 0.022) were associated with incident HF.
Conclusion
While most clinical parameters were not associated with incident HF in patients with CCC, echocardiographic parameters, including LV systolic and diastolic function and strain-derived parameters, were associated with incident HF in patients with CCC. This knowledge can be very useful for planning the care and follow-up of these patients.
目的慢性恰加斯心肌病(CCC)患者因心力衰竭(HF)死亡率高。本研究的目的是研究CCC患者发生HF的临床和超声心动图预测因素。方法采用单中心回顾性纵向观察研究,纳入176例成年患者(女性59.1%;53.9±10岁;平均左室[LV]射血分数62%±10%)(心电图和/或壁运动改变,但无HF)。主要结局为偶发性心衰。研究参数与心衰事件之间的关联通过竞争风险生存回归模型使用Fine和Gray方法进行。结果平均随访8.8±3.6年,42例进展为HF(27.04例/1000患者-年)。校正了临床和2d多普勒超声心动图参数以及全因死亡率的模型显示,糖尿病(HR 4.91, 95% CI 1.67-14.4, p = 0.004)、左室射血分数(HR 0.96, 95% CI 0.93-0.99, p = 0.022)和E ' velocity (HR 0.79, 95% CI 0.67-0.95, p = 0.01)与心衰事件独立相关。在模型0中加入应变衍生参数显示,LV整体周向应变(HR 0.83, 95% CI 0.78-0.89, p <;0.001)和左心房助推器收缩应变(HR 1.14, 95% CI 1.02-1.28, p = 0.022)与HF的发生相关。结论虽然大多数临床参数与CCC患者的HF事件无关,但超声心动图参数,包括左室收缩和舒张功能以及应变衍生参数,与CCC患者的HF事件相关。这些知识对于规划这些患者的护理和随访非常有用。
期刊介绍:
Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.