{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:50:54Z","timestamp":1785797454055,"version":"3.56.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0012114","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000}}],"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2011\/07648-0"],"award-info":[{"award-number":["2011\/07648-0"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medtronic Brazil"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Prognosis of Chronic Chagasic Cardiomyopathy (CCC) patients depends on functional and clinical factors. Bradyarrhythmia requiring pacemaker is a common complication. Prognosis of these patients is poorly studied, and mortality risk factors are unknown. We aimed to identify predictors of death and to define a risk score for mortality in a large cohort of CCC patients with pacemaker.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>It was an observational, unicentric and prospective study. The endpoint was all-cause mortality. Cox regression was used to identify predictors of death and to define a risk score. Bootstrapping method was used to internal score validation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We included 555 patients and after a mean follow-up of 3.7\u00b11.5 years, 100 (18%) deaths occurred. Predictors of death were: right ventricular dysfunction (HR [hazard ratio] 2.24; 95%CI 1.41\u20133.53; <jats:italic>P<\/jats:italic> = 0.001); heart failure class III or IV (HR 2.16; 95% confidence interval [95%CI] 1.16\u20134.00; <jats:italic>P<\/jats:italic> = 0.014); renal disease (HR 2.14; 95%CI 1.24\u20133.68; <jats:italic>P<\/jats:italic> = 0.006); left ventricular end-systolic diameter &gt; 44mm (HR 1.97; 95%CI 1.26\u20133.05; <jats:italic>P<\/jats:italic> = 0.003); atrial fibrillation (HR 1.94; 95%CI 1.25\u20132.99; <jats:italic>P<\/jats:italic> = 0.003) and cardiomegaly on X-ray (HR 1.87; 95%CI 1.10\u20133.17; <jats:italic>P<\/jats:italic> = 0.020). The score identified patients with: low (0\u201320 points), intermediate (21\u201330 points) and high risk (&gt;31points).<\/jats:p>\n<jats:p>The optimism-corrected C-statistic of the predictive model was 0.751 (95% CI 0.696\u20130.806). Internal validation with bootstrapping revealed a calibration slope of 0.946 (95% CI 0.920\u20130.961), reflecting a small degree of over-optimism and C-statistic of 0.746 (95% CI 0.692\u20130.785).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study identified predictors of mortality in CCC patients with pacemaker defining a simple, validated and specific risk score.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0012114","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:56:34Z","timestamp":1715277394000},"page":"e0012114","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mortality risk score for patients with Chagas cardiomyopathy and pacemaker"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3970-3558","authenticated-orcid":true,"given":"Giselle","family":"de Lima Peixoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9rgio Freitas","family":"de Siqueira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana Angelina D\u2019Orio","family":"Nishioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An\u00edsio Alexandre Andrade","family":"Pedrosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Alkmim","family":"Teixeira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martino","family":"Martinelli Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"key":"pntd.0012114.ref001","first-page":"767","article-title":"Council on Chagas Disease of the Interamerican Society of Cardiology Chagas disease: an overview of clinical and epidemiological aspects","volume":"62","author":"MCP Nunes","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"pntd.0012114.ref002","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1136\/hrt.2008.159624","article-title":"Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas\u2019 disease","volume":"95","author":"AJ Rassi","year":"2009","journal-title":"Heart"},{"key":"pntd.0012114.ref003","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.actatropica.2009.11.003","article-title":"Chagas disease: a Latin American health problem becoming a world health problem","volume":"115","author":"GA Schmunis","year":"2010","journal-title":"Acta Trop"},{"key":"pntd.0012114.ref004","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/S1473-3099(01)00065-2","article-title":"Clinical and epidemiological aspects of Chagas disease","volume":"1","author":"A Prata","year":"2001","journal-title":"Lancet Infect Dis"},{"key":"pntd.0012114.ref005","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1161\/CIRCULATIONAHA.112.123612","article-title":"Ten-year incidence of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-seropositive former blood donors","volume":"127","author":"EC Sabino","year":"2013","journal-title":"Circulation"},{"key":"pntd.0012114.ref006","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1161\/CIRCULATIONAHA.106.624296","article-title":"Pathogenesis of chronic Chagas heart disease","volume":"115","author":"JA Marin-Neto","year":"2007","journal-title":"Circulation"},{"key":"pntd.0012114.ref007","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1056\/NEJMoa1507574","article-title":"Randomized Trial of Benznidazole for Chronic Chagas\u2019 Cardiomyopathy","volume":"373","author":"CA Morillo","year":"2015","journal-title":"N Engl J Med"},{"key":"pntd.0012114.ref008","doi-asserted-by":"crossref","first-page":"e011181","DOI":"10.1136\/bmjopen-2016-011181","article-title":"Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile","volume":"6","author":"CS Cardoso","year":"2016","journal-title":"BMJ Open"},{"key":"pntd.0012114.ref009","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1590\/S0066-782X2007000200004","article-title":"Remodelamento ventricular na estimula\u00e7\u00e3o card\u00edaca apical do ventr\u00edculo direito","volume":"88","author":"RT Silva","year":"2007","journal-title":"Arq Bras Cardiol"},{"key":"pntd.0012114.ref010","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.amjcard.2012.05.040","article-title":"Long-term follow-up of implantable cardioverter-defibrillator for secondary prevention in chagas\u2019 heart disease","volume":"110","author":"M Martinelli","year":"2012","journal-title":"Am J Cardiol"},{"key":"pntd.0012114.ref011","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1056\/NEJMoa053241","article-title":"Development and validation of a risk score for predicting death in Chagas\u2019 heart disease","volume":"355","author":"A Rassi","year":"2006","journal-title":"N Engl J Med"},{"key":"pntd.0012114.ref012","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1111\/j.1540-8167.2007.01088.x","article-title":"Prognostic value of signal-averaged electrocardiogram in Chagas disease","volume":"19","author":"ALP Ribeiro","year":"2008","journal-title":"J Cardiovasc Electrophysiol"},{"key":"pntd.0012114.ref013","first-page":"e210","article-title":"Guidelines for Implantable Electronic Cardiac Devices of the Brazilian Society of Cardiology","volume":"89","author":"M Martinelli Filho","year":"2007","journal-title":"Arq Bras Cardiol"},{"key":"pntd.0012114.ref014","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1161\/CIRCULATIONAHA.106.627265","article-title":"Predictors of mortality in chronic Chagas disease: A systematic review of observational studies","volume":"115","author":"A Rassi","year":"2007","journal-title":"Circulation"},{"key":"pntd.0012114.ref015","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ahj.2016.03.023","article-title":"Atrial fibrillation without comorbidities: Prevalence, incidence and prognosis (from the Framingham Heart Study)","volume":"177","author":"E-J Kim","year":"2016","journal-title":"Am Heart J"},{"key":"pntd.0012114.ref016","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/jce.12845","article-title":"The Prevalence of Atrial Fibrillation and Conduction Abnormalities in Chagas\u2019 Disease: A Meta-Analysis","volume":"27","author":"R Cardoso","year":"2016","journal-title":"J Cardiovasc Electrophysiol"},{"key":"pntd.0012114.ref017","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1111\/pace.12013","article-title":"Permanent Pacing in Patients with Chagas\u2019 Disease","volume":"35","author":"M Arce","year":"2012","journal-title":"Pacing Clin Electrophysiol"},{"issue":"2","key":"pntd.0012114.ref018","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3390\/tropicalmed5020074","article-title":"New Imaging Parameters to Predict Sudden Cardiac Death in Chagas Disease","volume":"5","author":"RJ Moll-Bernardes","year":"2010","journal-title":"Trop Med Infect Dis"},{"key":"pntd.0012114.ref019","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.ijcard.2015.03.372","article-title":"Development of a risk score to predict sudden death in patients with Chaga\u2019s heart disease","volume":"187","author":"ACJ Souza","year":"2015","journal-title":"Int J Cardiol"},{"key":"pntd.0012114.ref020","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1016\/j.hrthm.2009.03.055","article-title":"Nonsustained pacemaker-mediated tachycardia during biventricular pacing: what is the mechanism?","volume":"6","author":"M Jastrzebski","year":"2009","journal-title":"Heart Rhythm"},{"key":"pntd.0012114.ref021","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1586\/erc.12.115","article-title":"Device therapy in Chagas disease heart failure","volume":"10","author":"RB Bestetti","year":"2012","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"pntd.0012114.ref022","doi-asserted-by":"crossref","first-page":"e014176","DOI":"10.1161\/JAHA.119.014176","article-title":"Risk Score for Predicting 2-Year Mortality in Patients With Chagas Cardiomyopathy From Endemic Areas: SaMi-Trop Cohort Study","volume":"9","author":"C Di Lorenzo Oliveira","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"pntd.0012114.ref023","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.ijcard.2017.10.031","article-title":"Predictors of death in chronic Chagas cardiomyopathy patients with pacemaker","volume":"250","author":"GL Peixoto","year":"2018","journal-title":"Int J Cardiol"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0012114","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000}},{"DOI":"10.1371\/journal.pntd.0012928","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T17:45:55Z","timestamp":1718041555000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012114"}},"subtitle":[],"editor":[{"given":"Susan","family":"Madison-Antenucci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,9]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0012114","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0012114","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,9]]}}}