Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Mar 2020)

Risk Score for Predicting 2‐Year Mortality in Patients With Chagas Cardiomyopathy From Endemic Areas: SaMi‐Trop Cohort Study

  • Claudia Di Lorenzo Oliveira,
  • Maria Carmo P. Nunes,
  • Enrico Antonio Colosimo,
  • Emilly Malveira de Lima,
  • Clareci S. Cardoso,
  • Ariela Mota Ferreira,
  • Lea Campos de Oliveira,
  • Carlos Henrique Valente Moreira,
  • Ana Luiza Bierrenbach,
  • Desireé Sant′Ana Haikal,
  • Sérgio Viana Peixoto,
  • Maria Fernanda Lima‐Costa,
  • Ester Cerdeira Sabino,
  • Antonio Luiz P. Ribeiro

DOI
https://doi.org/10.1161/JAHA.119.014176
Journal volume & issue
Vol. 9, no. 6

Abstract

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Background Risk stratification of Chagas disease patients in the limited‐resource setting would be helpful in crafting management strategies. We developed a score to predict 2‐year mortality in patients with Chagas cardiomyopathy from remote endemic areas. Methods and Results This study enrolled 1551 patients with Chagas cardiomyopathy from Minas Gerais State, Brazil, from the SaMi‐Trop cohort (The São Paulo‐Minas Gerais Tropical Medicine Research Center). Clinical evaluation, ECG, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were performed. A Cox proportional hazards model was used to develop a prediction model based on the key predictors. The end point was all‐cause mortality. The patients were classified into 3 risk categories at baseline (low, <2%; intermediate, ≥2% to 10%; high, ≥10%). External validation was performed by applying the score to an independent population with Chagas disease. After 2 years of follow‐up, 110 patients died, with an overall mortality rate of 3.505 deaths per 100 person‐years. Based on the nomogram, the independent predictors of mortality were assigned points: age (10 points per decade), New York Heart Association functional class higher than I (15 points), heart rate ≥80 beats/min (20 points), QRS duration ≥150 ms (15 points), and abnormal NT‐proBNP adjusted by age (55 points). The observed mortality rates in the low‐, intermediate‐, and high‐risk groups were 0%, 3.6%, and 32.7%, respectively, in the derivation cohort and 3.2%, 8.7%, and 19.1%, respectively, in the validation cohort. The discrimination of the score was good in the development cohort (C statistic: 0.82), and validation cohort (C statistic: 0.71). Conclusions In a large population of patients with Chagas cardiomyopathy, a combination of risk factors accurately predicted early mortality. This helpful simple score could be used in remote areas with limited technological resources.

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