A novel risk score for predicting new-onset atrial fibrillation in subjects with chronic chagas heart disease
A novel risk score for predicting new-onset atrial fibrillation in subjects with chronic chagas heart disease
Data
2010
Autores
Barbosa, Paulo R.
Tura, Bernardo R.
Barbosa-Filho, José
Kantharia, Bharat K.
Journal Title
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Publisher
Heart Rhythm
Resumo
Introduction: Atrial fibrillation affects about 20% of subjects with chronic Chagas disease (CCD) and heralds poor prognosis. This study prospectively investigated echocardiographic and electrocardiographic parameters aiming at creating a risk score for new-onset AF (NOAF) in CCD and to compare its performance to Rassi score.
Methods: Clinically stable outpatients with CCD (34 to 74 y.o, 38 males) staged according to Los Andes (Class I: N=28; II: N=48; III: N=24) were enrolled. Patients were assessed by 12-lead
ECG, 24h ambulatory ECG and 1D/2D echocardiogram. NOAF lasting >24h was tracked at three to six-month intervals.
Results: During a follow-up of (mean±SEM) 91.2 ± 3.2 months, 18 developed NOAF (incidence: 30.2 ± 2.6 /year), and 20 died (rate: 26.4 ± 1.4 /year). Relative risk of NOAF for cardiac death
was 3.6 (p=0.001). In multivariate Cox proportional hazard model, PVC>3,000/24h (p=0.02), LAD>3.3cm (p=0.001), and PAP>30mmHg (p=0.004) were independent predictors for NOAF
(Table inset). A prognostic score for NOAF was developed by calculating weighted points proportional to beta coefficient in Cox model (table inset). ROC analysis of novel score showed optimal cut-off value at 2 (Figure A). KM curves of novel score for NOAF is presented in Figure B (proportional hazard test: rho=0.1; p=0.6). In 1,000 bootstraps, ROC c-statistic of novel score was
significantly superior to Rassi score (Figure C).
Conclusions: In CCD, high grade PVC, LAD>3.3cm and PAP>30mmHg are independent predictors for NOAF. Novel risk score improves NOAF predictive accuracy in this population.
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Citação
Barbosa PB, Tura BR, Barbosa-Filho J, Kantharia BK. A novel risk score for predicting new-onset atrial fibrillation in subjects with chronic chagas heart disease. Heart rhythm. 2010; 7(5): S216. Doi: 10.1016/j.hrthm.2010.03.031.