Bellotti G

Survival and predictors of survival in patients with congestive heart failure due to Chagas' cardiomyopathy.

BackgroundThe fundamental determinant of the natural history of Chagas disease is cardiac involvement. Methods and ResultsWe studied 104 male patients with congestive heart failure due to Chagas disease to estimate the survival distribution function and to evaluate age, functional class (FC), maximal oxygen consumption (&OV0622;O2max), and ejection fraction (EF) as predictors of survival. Statistical evaluation was performed through univariate (Students t test and χ2 test) and multivariate analyses (Coxs regression model). Overall survival was 66% at 1 year, 56% at 3 years, and 48% at 5 years. Ages were not statistically different (P = .9811) between survivor (40.3 ± 8.7) and nonsurvivor (40.3 ± 9.4) groups. The ejection fraction(s) were statistically different (P = .0001) between survival (43.6 ± 9.9) and nonsurvival (30.6 ± 8.1) groups, as was &OV0622;O2max (P = .0001) (21.0 ± 4.7 and 15.0 ± 4.9, respectively). Most of the surviving patients were in FC II and most of the nonsurvivors were in FC IV (P = .0001). &OV0622;O2max (P = .0001) and EF (P = .0008) are highly associated with survival time in the multivariate analysis, but FC (P = .0578) is less important. Age (P = .9811) did not influence survival. ConclusionsWe conclude that 50% of the patients with heart failure due to Chagas disease die in 47 months and that &OV0622;O2max and EF are important indices of survival in this group.

Frequency and significance of cardiac rhythm disturbances in healthy elderly individuals

The authors examined the prevalence and significance of cardiac rhythm disturbances in healthy elderly individuals. They selected 26 men with active lifestyles, aged 70-81 years, after clinical, routine blood tests, chest radiographs, echocardiography, resting and exercise electrocardiography, and Gated cardiac blood imaging evaluations. The men were submitted to continuous electrocardiographic monitoring during their daily routine. The recording time ranged from 838 to 1,432 min (average = 1,307 +/- 153 min). Clinical follow-up was done every six months. Sinus rhythm predominated in all subjects. The maximal, minimal, and average heart rate ranges (beats/min) were, respectively: during sleeping periods, 60-115 (85.8 +/- 13.2), 42-80 (56.6 +/- 8.7), 51-85 (64.0 +/- 8.8); and during awake periods, 85-150 (118.4 +/- 16.4), 50-85 (64.1 +/- 9.1), 61-90 (75.3 +/- 8.3). The longest sinus pauses were observed during sleep and ranged from 0.8 to 2.5 sec (1.25 +/- 0.34 sec). Atrial ectopic beats were observed in 20 individuals (76.9%). They were frequent in four (15.4%) and repetitive in nine (34.6%) of them. Short-lasting episodes of paroxysmal atrial tachycardia and paroxysmal atrial flutter were observed in one case each. Ventricular ectopic beats were recorded in 20 individuals (76.9%). They were frequent in 6 (23%) and multiform in 13 (50%) of them. Couplets were observed in 5 cases (19.2%) and episodes of nonsustained ventricular tachycardia were present in 3 individuals (11.5%). No symptoms were referred by any individual during recording. No clinical signs of heart disease or symptoms were noticed during the average 40 +/- 7.2 months of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

A portable and simple microcomputer system for quantitative assessment of cardiovascular therapy in critical patients

The authors describe a portable system that can record electrical and hemodynamic signals and provide accurate information on trend parameters to control treatment in intensive-care units (ICUs). The hardware is a PC-XT-compatible computer with 640 kbytes, equipped with an A/D converter. The software is implemented in Pascal and assembly languages and consists of configuration, acquisition, and analysis modules. Patients with severe congestive heart failure are studied before and after drug administration. The electrocardiogram, pressure values (right atrium, pulmonary artery, femoral artery), first-derivative impedance wave, and cardiac output are obtained. The data are continuously sampled and stored. The system allows a bedside quantitative analysis of the effects of drugs on cardiovascular function and improves the monitoring of critical patients in the ICU.<<ETX>>