Abstract 16141: Predictors of Death in Patients With Chagas Cardiomyopathy and Pacemaker - Preliminary Results of the PACINCHAGAS Study

Abstract

Introduction: Chagas’ disease causes different clinical expressions in the heart and permanent pacing due to bradycardia is not uncommon. Objective: Predictors of death in patients with Chagas Cardiomyopathy requiring pacemaker (PM) are unknown. This is the aim of this study. Methods: We prospectively evaluated 529 patients included in the Pacinchagas Study - Risk Stratification in Pacemaker Patients with Chagas Cardiomyopathy, which primary objective is to create a risk score to predict death in this population. The patients are submitted to an extent questionnaire which included clinical (NYHA class, symptoms, comorbidities and medications) functional (electrocardiography, Holter and echocardiography) and electronic variables (burden of pacing and arrhythmias). Patients with at least 6 months of follow-up were included in this preliminar analysis. Results: The cohort included 337 (63.7%) females, the mean age was 62.3±11.9 years and 63.1% were in NYHA class I. Indication for PM implantation was atrioventricular block, sick sinus syndrome, atrial fibrillation with slow ventricular response and unknown in 72.0%; 20.4%; 5.1% and 2.5%, respectively. During a mean follow-up of 1.5±0.6 years, 62 (11.7%) patients died. The mean time of PM implantation was not different between the dead and the survivors (11.9±9.0years versus 11.1±8.6years, P=0.503). Twenty-five deaths (40.3%) were sudden, 22 (35.5%) were due to heart failure, 6 (9.7%) were due to other cardiovascular causes, and 7 (11.3%) were due to noncardiovascular causes. The cause of death could not be determined in two patients (3.2%). Cox proportional hazards identified three predictors of death: NYHA class III/IV (Hazard Ratio [HR] 5.661; 95% Confidence Interval [95%IC] 2.617-12.245; P<0.001); left ventricular ejection fraction (LVEF) ≤42% (HR 2.779; 95%IC 1.299-5.945; P=0.008) and chronic kidney disease (HR 2.635; 95%IC 1.167-5.948; P=0.020). Conclusions: This analysis of Pacinchagas study identified in a mean follow-up of one year and half, three predictors of death in PM users with Chagas Cardiomyopathy: NYHA class III/IV, LVEF≤42% and chronic kidney disease.