ABSTRACT
The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC) is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox’s univariate model) and multivariate (Cox regression model) analysis. Patients were followed from two to 20 years (mean: 8.2). Their mean age was 44.8 years (20-77). Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01). The predictors for CCC progression in the final regression model were male gender (HR = 2.81), Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02) increased cardiothoracic ratio (HR = 7.87) and time of use of digitalis (HR = 1.41). Patients with multiple predictive factors require stricter follow-up and treatment.
A identificação de preditores da progressão da cardiopatia chagásica crônica (CCC) é essencial ao manejo adequado do paciente. Estudo coorte não concorrente de 165 pacientes portadores de CCC entre 1985-2010 quanto a preditores independentes da evolução da CCC. Os desfechos foram piora da classificação da CCC e surgimento de disfunção ventricular esquerda ao ecoDopplercardiograma. Variáveis sócio-demográficas, epidemiológicas, clínicas e propedêuticas foram estudadas e realizadas análise descritiva, análise de sobrevida com análise univariada (Kaplan-Meier e modelo univariado de Cox) e multivariada (modelo de regressão de Cox). O seguimento foi de dois a 20 anos, com média de 8,2 anos. A média de idade dos pacientes foi de 44,8 anos (20- 77 anos). Comparando ambos os tempos do estudo, no tempo 2 houve significância estatística do aumento do intervalo PR e da duração do QRS, além da redução da frequência cardíaca (Wilcoxon < 0,01). Os preditores da evolução da CCC no modelo final de regressão foram sexo masculino (HR = 2,81), pausas iguais ou maiores que dois segundos ao Holter (HR = 3,02), aumento do índice cardiotorácico (HR = 7,87) e tempo de uso de digital (HR = 1,41), destacando-se necessidade de seguimento e tratamento mais rigoroso para os chagásicos que cumulam estes fatores.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Chagas Cardiomyopathy/mortality , Chagas Cardiomyopathy/physiopathology , Disease Progression , Electrocardiography , Kaplan-Meier Estimate , Risk Factors , Socioeconomic Factors , Ventricular Function, LeftABSTRACT
A case-control study on chronic Chagas heart disease (CCHD) was carried out between 1997 and 2005. Ninety patients over 50 years of age were examined for factors related to (CCHD). Fourty-six patients (51.1 percent) with Chagas heart disease (anomalous ECG) were assigned to the case group and 44 (48.9 percent) were included in the control group as carriers of undetermined forms of chronic disease. Social, demographic (age, gender, skin color, area of origin), epidemiological (permanence within an endemic zone, family history of Chagas heart disease or sudden death, physical strain, alcoholism, and smoking), and clinical (systemic hypertension) variables were analyzed. The data set was assessed through single-variable and multivariate analysis. The two factors independently associated with heart disease were age - presence of heart disease being three times higher in patients over 60 years of age (odds ratio, OR: 2.89; confidence interval of 95 percent: 1.09-7.61) - and family history of Chagas heart disease (OR: 2.833, CI 95 percent: 1.11-7.23). Systemic hypertension and gender did not prove to hold any association with heart disease, as neither did skin color, but this variable showed low statistical power due to reduced sample size.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Chagas Cardiomyopathy/epidemiology , Age Factors , Brazil/epidemiology , Case-Control Studies , Chronic Disease , Chagas Cardiomyopathy/etiology , Multivariate Analysis , Risk Factors , Socioeconomic FactorsABSTRACT
Os autores descrevem as principais características das doenças na idade avançada (co-morbidades, doenças crônico-degenerativas, apresentação atípica e inespecífica, etiologia múltipla, resposta imprevisível ao tratamento), a sua forma mais freqüente de apresentação (gigantes da Geriatria), assim como a dificuldade de reconhecimento das enfermidades nesta faixa etária (fenômeno do iceberg). A avaliação do paciente idoso deve obrigatoriamente incluir as áreas psíquica, clínica, funcional, nutricional e social, além de uma descrição minuciosa das drogas em uso. A abordagem dos complexos e variados problemas médicos dos idosos usualmente requer a atuação de uma equipe intermultidisciplinar