Predictors of heart failure in chronic chagasic cardiornyopathy with asymptornatic left ventricular dysfunction

Introduction and objectives. The development of asymptomatic left ventricular dysfunction signifies a worsening of chronic chagasic cardionnyopathy. Our objective was to identify factors that predict the development of heart failure and all-cause mortality. Methods. The study included 95 patients with an echocardiographic diagnosis of asymptomatic left ventricular dysfunction. The patients' clinical, electrocardiographic and echocardiographic characteristics were recorded. Factors associated with the development of heart failure were evaluated by Cox regression modeling. Hazard ratios (HRs) and 95% confidence intervals (Cls) were calculated. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of continuous variables identified as significant in the regression analysis. Results. Patients (mean age, 55 [11] years) were followed up for a median of 63 months (interquartile range, 32-110 months). Univariate analysis showed that there were significant differences in mild and severe systolic dysfunction, age on admission, and E-point-to-septal separation, while the only significant predictors of heart failure found on Cox regression analysis were severe systolic dysfunction (HR=3.53; 95% Cl, 1.21-10.30; P=.021) and E-point-to-septal separation (HR=1.12; 95% Cl, 1.02-1.23; P=.014). The mortality rate was 3% (3/95) in patients who continued to have asymptornatic left ventricular dysfunction and 37% (10/27) in those who developed heart failure. Conclusions. The E-point-to-septal separation and the presence of severe systolic dysfunction can serve as predictors of heart failure in patients with chronic chagasic cardiomyopathy and asymptomatic left ventricular dysfunction.