Dissertation
Pronostico de mortalidad en una cohorte de pacientes portadores de Miocardiopatía Dilatada por Enfermedad de Chagas Crónica Argentina
Predict mortality in a cohort of patients with dilated cardiomyopathy and Chagas Disease Chronic Argentina
Registro en:
PRADO, Nilda Graciela. Pronostico de mortalidad en una cohorte de pacientes portadores de Miocardiopatía Dilatada por Enfermedad de Chagas Crónica Argentina. 2010. 77 f. Dissertação (Mestrado em Epidemiologia em Saúde Pública) - Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, 2010.
Autor
Prado, Nilda Graciela
Resumen
INTRODUCTION AND OBJETIVES
The most advanced state of the Cronical Chagas Desease is manifested by a
prolonged and irreversible evolution of a myocardiopathy causing in the process
early disability and mortality.
The main objective of this study was to analyse mortality predictors considering a
patient cohort affected by the Chagas Desease with advanced Myocardial
Compromise.
MATERIAL AND METHOD
For the development of the study a prospective cohort design was employed.
The analysis considered a total number of 96 patients being subject to an specific
treatment based on 2 or 3 reactive techniques and employed for Asymptomatic
Chagas Desease involing Left Ventricular Dilation Cardiopathy (Kurchnir´s II state)
or Heart Failure signs ( Kurchnir´s III state).
In accordance with traditional mortality rate analysis, demographic, clinical, electro
and ecocardiographic variables were included.
In the Mortality rate analysis were employed Kaplan-Meier curves first and the Cox
approach to proportional risk analysis later on in order to adopt the most accurate
model represeting Mortality rate results.
RESULT
At study entry, the patients’ mean age was 57 years. They were followed up for
a mean of 2.6 years. A number of 30 (28.8 %) out of those total of 96 patients died.
The deceased group proved to be significantly much younger (52 vs 59, p=0.01). In
the Cox Mortality Analysis appears age as the protective variable (HR:0.96,
p=0.039), The functional III – IV Clase (HR: 2.39, p=0.063) and the dilation of the
right cavities (HR: 2.41, p=0.029)
CONCLUSIONS
In the Chagas Desease with myocardial compromise it is possible to determine
a higher mortality risk for younger patients with inappropriate functional class as a
result of associating the already left compromise, the dilation of the right ventricular
and atrial cavities. Introducción y objetivos
El compromiso más avanzado de la Enfermedad de Chagas (ECH) crónica
se manifiesta por una miocardiopatía de evolución lenta, progresiva e irreversible,
originando discapacidad precoz y muerte temprana.
El objetivo principal de este estudio fue analizar predictores de mortalidad en una
cohorte de pacientes con ECH y compromiso miocárdico avanzado.
Material y método
Se utilizó un diseño de cohortes prospectivo que incluyó 96 pacientes con
2 o 3 técnicas reactivas para Enfermedad de Chagas con dilatación ventricular
izquierda y asintomáticos (Estadio II de Kurchnir) o con signos de insuficiencia
cardíaca ( Estadio III de Kurchnir). Se incluyeron variables demográficas, clínicas,
electro y ecocardiográficas en un análisis tradicional de sobrevida y como punto
final la muerte cardiovascular. En el análisis del tiempo de sobrevida se utilizaron
las curvas de Kaplan Meier y luego se utilizó un análisis de riesgos proporcionales
de Cox hasta encontrar el modelo que mejor ajuste tuvo con mortalidad.
Resultados
La media de edad fue de 57 años y fueron seguidos 2.6 años promedio.
Treinta de 96 pacientes (28.8%) fallecieron. El grupo fallecido resultó ser
significativamente más joven (52 vs 59,p=0.01) .En el análisis de Cox para
mortalidad surge la edad como variable protectora (RR:0.96, p =0.039), la clase
funcional III –IV (RR:2.39, p= 0.063) y la dilatación de las cavidades derechas
(RR:2.41, p= 0.029)
Conclusiones:
En la Enfermedad de Chagas con compromiso miocárdico es posible
determinar mayor riesgo de mortalidad en pacientes jóvenes con inadecuada
clase funcional y asociada, al ya presente compromiso izquierdo, la dilatación de
las cavidades derechas.
Materias
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