Avaliação do Prognóstico na Cardiomiopatia Chagásica através do Teste Cardiopulmonar de Exercício
Avaliação do Prognóstico na Cardiomiopatia Chagásica através do Teste Cardiopulmonar de Exercício
Data
2015
Autores
Souza, Fernando Cesar de Castro e
De Lorenzo, Andrea
Serra, Salvador Manoel
Colafranceschi, Alexandre Siciliano
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Cardiovascular Sciences
Resumo
Fundamentos: A insuficiência cardíaca de etiologia chagásica (ICCh) parece ter maior mortalidade que a de outras com disfunção sistólica. O teste cardiopulmonar de exercício (TCPE) é uma ferramenta de avaliação prognóstica ainda pouco estudada na cardiopatia chagásica. Objetivo: Avaliar se o TCPE pode discriminar as diferenças prognósticas da ICCh em comparação às de etiologia não chagásica (ICNCh) e verificar quais das suas variáveis são preditoras independentes de mau prognóstico. Métodos: Análise retrospectiva de 21 pacientes com ICCh e 76 pacientes com ICNCh encaminhados ao TCPE, e seguidos quanto à sua mortalidade em dois anos. Resultados: No seguimento, houve óbito de 5 pacientes no grupo chagásico (GC) e 25 no grupo não chagásico (GNC). A curva de Kaplan-Meier não mostrou diferença na curva de sobrevida entre os grupos (p=0,43). A regressão logística encontrou a potência circulatória como uma variável preditora independente para óbito para ambos os grupos, com uma razão de risco para o GC de 17,3 (IC95% 1,39-217,0; p=0,027) e no GNC de 4,8 (IC95% 1,59-14,6; p=0,005). A curva ROC para esta variável encontrou uma área de 0,91 (IC95% 0,78-1,00; p=0,006) com um valor de corte ≤1280mmHg.mL.kg-1.min-1 no GC e uma área de 0,75 (IC95% 0,64-0,86; p<0,0001) com um valor de corte de ≤1245mmHg.mL.kg-1.min-1 no GNC. Conclusão: A potência circulatória foi a variável associada à morte em ambos os grupos, e deve ser mais amplamente utilizada como indicador de prognóstico na insuficiência cardíaca.
Background: Chagas heart failure (CHF) seems to have higher mortality than other systolic dysfunction conditions. Cardiopulmonary exercise testing (CPET) is a prognostic assessment tool that is still little studied in Chagas heart disease. Objective: To assess whether CPET can discriminate the prognostic differences of CHF compared to non-Chagas heart failures (NCHF) and determine which of its variables are independent predictors of poor prognosis. Methods: Retrospective analysis of 21 patients with CHF and 76 patients with NCHF referred to CPET and followed up for mortality in two years. Results: During follow-up, 5 patients died in the Chagas group (CG) and 25 in the non-Chagas group (NCG). The Kaplan-Meier curve showed no difference in the survival curve between groups (p=0.43). Logistic regression found the circulatory power as an independent predictor of death for both groups, with a hazard ratio for the CG of 17.3 (95% CI 1.39-217.0; p=0.027) and for the NCG of 4.8 (95% CI 1.59-14.6; p=0.005). The ROC curve for this variable found an area of 0.91 (95% CI 0.78-1.00; p=0.006) with a cutoff value ≤1280mmHg.mL.kg-1.min-1 in the CG and an area of 0.75 (95% CI 0.64-0.86; p<0.0001) with a cutoff value of ≤1245mmHg.mL.kg-1.min-1 in the NCG. Conclusion: Circulatory power was the variable associated with death in both groups and should be more widely used as an indicator of prognosis in heart failure.
Background: Chagas heart failure (CHF) seems to have higher mortality than other systolic dysfunction conditions. Cardiopulmonary exercise testing (CPET) is a prognostic assessment tool that is still little studied in Chagas heart disease. Objective: To assess whether CPET can discriminate the prognostic differences of CHF compared to non-Chagas heart failures (NCHF) and determine which of its variables are independent predictors of poor prognosis. Methods: Retrospective analysis of 21 patients with CHF and 76 patients with NCHF referred to CPET and followed up for mortality in two years. Results: During follow-up, 5 patients died in the Chagas group (CG) and 25 in the non-Chagas group (NCG). The Kaplan-Meier curve showed no difference in the survival curve between groups (p=0.43). Logistic regression found the circulatory power as an independent predictor of death for both groups, with a hazard ratio for the CG of 17.3 (95% CI 1.39-217.0; p=0.027) and for the NCG of 4.8 (95% CI 1.59-14.6; p=0.005). The ROC curve for this variable found an area of 0.91 (95% CI 0.78-1.00; p=0.006) with a cutoff value ≤1280mmHg.mL.kg-1.min-1 in the CG and an area of 0.75 (95% CI 0.64-0.86; p<0.0001) with a cutoff value of ≤1245mmHg.mL.kg-1.min-1 in the NCG. Conclusion: Circulatory power was the variable associated with death in both groups and should be more widely used as an indicator of prognosis in heart failure.
Description
Palavras-chave
Teste de Esforço, Doença de Chagas, Insuficiência Cardíaca, Prognóstico, Exercise Test, Chagas Disease, Heart Failure, Prognosis
Citação
Souza FCC, De Lorenzo A, Serra SM, Colafranceschi AS. Avaliação do Prognóstico na Cardiomiopatia Chagásica através do Teste Cardiopulmonar de Exercício. Int J Cardiovasc Sci. 2015;28(6):440-450