Key result
A novel ECG-derived score was non-inferior to the Rassi score for predicting cardiac death and new onset VT in chronic Chagas disease (C-statistic 0.89 vs 0.80; P<0.001 for non-inferiority).
Why the study?
Does a novel ECG-derived risk score predict cardiac death and new onset VT in clinically stable outpatients with chronic Chagas disease?
Cohort (n=100)
Does a novel ECG-derived risk score predict cardiac death and new onset VT in clinically stable outpatients with chronic Chagas disease?
Absolute Event Rate: 0.89% vs 0.8%
p-value: p=<0.001
A novel risk score using surface ECG-derived variables effectively predicts cardiac death and new onset ventricular tachycardia in patients with chronic Chagas disease, performing non-inferiorly to the established Rassi score.
May support ECG-based stratification in chronic Chagas outpatients; leaves open prospective validation and outcome impact.
The SEARCH-RIO study prospectively investigated electrocardiogram (ECG)-derived variables in chronic Chagas disease (CCD) as predictors of cardiac death and new onset ventricular tachycardia (VT). Cardiac arrhythmia is a major cause of death in CCD, and electrical markers may play a significant role in risk stratification. One hundred clinically stable outpatients with CCD were enrolled in this study. They initially underwent a 12-lead resting ECG, signal-averaged ECG, and 24-h ambulatory ECG. Abnormal Q-waves, filtered QRS duration, intraventricular electrical transients (IVET), 24-h standard deviation of normal RR intervals (SDNN), and VT were assessed. Echocardiograms assessed left ventricular ejection fraction. Predictors of cardiac death and new onset VT were identified in a Cox proportional hazard model. During a mean follow-up of 95.3 months, 36 patients had adverse events: 22 new onset VT (mean±SD, 18.4±4/year) and 20 deaths (26.4±1.8/year). In multivariate analysis, only Q-wave (hazard ratio, HR=6.7; P<0.001), VT (HR=5.3; P<0.001), SDNN<100 ms (HR=4.0; P=0.006), and IVET+ (HR=3.0; P=0.04) were independent predictors of the composite endpoint of cardiac death and new onset VT. A prognostic score was developed by weighting points proportional to beta coefficients and summing-up: Q-wave=2; VT=2; SDNN<100 ms=1; IVET+ =1. Receiver operating characteristic curve analysis optimized the cutoff value at >1. In 10,000 bootstraps, the C-statistic of this novel score was non-inferior to a previously validated (Rassi) score (0.89±0.03 and 0.80±0.05, respectively; test for non-inferiority: P<0.001). In CCD, surface ECG-derived variables are predictors of cardiac death and new onset VT.
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Benchimol‐Barbosa et al. (2013) conducted a cohort in chronic Chagas disease (n=100). Novel ECG-derived prognostic score vs. Rassi score was evaluated on C-statistic for predicting cardiac death and new onset ventricular tachycardia (p=<0.001). A novel ECG-derived score was non-inferior to the Rassi score for predicting cardiac death and new onset VT in chronic Chagas disease (C-statistic 0.89 vs 0.80; P<0.001 for non-inferiority).
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