Cardiomyopathy Scores

Rassi Score Calculator – Chagas Cardiomyopathy Mortality Risk

Clinical calculation support · Verify results before clinical use

Mortality Risk Assessment

Select the clinical and investigation findings documented for the patient.

—Total points
Rassi score variables
NYHA

NYHA functional class III or IV

Advanced functional limitation consistent with NYHA class III or IV.

+5 points
CXR

Cardiomegaly on chest radiograph

Cardiothoracic index (CTI) >0.50 on chest X-ray.

+5 points
ECHO

Abnormal LV contractility on echocardiography

Any segmental or global LV contractility abnormality. This is not an LVEF cutoff.

+3 points
Holter

Nonsustained ventricular tachycardia

On 24-hour Holter: ≥3 consecutive ventricular beats, rate >100 bpm, lasting <30 seconds.

+3 points
ECG

Low-voltage QRS on ECG

QRS amplitude ≤0.5 mV in all frontal-plane leads.

+2 points
Sex

Male sex

Sex variable as defined in the original score.

+2 points
Applicability check
The original score excluded patients older than 70 years. Age does not contribute points.
!

Permanent pacemaker

Select Yes if this condition is present.

Exclusion
!

Previously documented sustained VT or ventricular fibrillation

Select Yes if this condition is present.

Exclusion
!

Coexisting ischemic, hypertensive, or valvular heart disease

Select Yes if this condition is present.

Exclusion
—Rassi score
Mortality risk category
Complete applicability check
Enter patient age and review the eligibility criteria to calculate the score.
Clinical interpretationThe score will be displayed when the applicability check is complete.
VariablePoints

Risk estimates represent group-level mortality observed in the original cohorts, not an individualized probability.

About the Rassi Score

The Rassi score (also referred to as the RASSI score in the 2023 Brazilian Society of Cardiology guideline) is a prognostic score developed to stratify long-term mortality risk in patients with chronic Chagas cardiomyopathy.

Six independent prognostic variables contribute a total of 0–20 points. The 2023 Brazilian guideline presents the echocardiographic variable as segmental or global LV contractility change and specifies operational definitions for cardiomegaly, NSVT, and low QRS voltage.

Variables and points

VariableDefinitionPoints
NYHA class III/IVFunctional class III or IV5
CardiomegalyCTI >0.50 on chest X-ray5
LV contractility changeSegmental or global abnormality on echocardiography3
NSVT≥3 beats, rate >100 bpm, duration <30 s on 24-h Holter3
Low QRS voltage≤0.5 mV in all frontal-plane leads2
Male sexMale2

Risk categories and observed mortality

Total scoreRisk group5-year mortality10-year mortality
0–6Low2%10%
7–11Intermediate18%44%
12–20High63%84%

Population and exclusions

The score was developed in outpatients with Chagas heart disease. The 2023 SBC guideline notes that patients older than 70 years, those with a permanent pacemaker, documented sustained VT or VF, and those with ischemic, hypertensive, or associated valvular disease were excluded from score calculation and standardization. Such patients are flagged by this calculator as outside the original validated population.

References

Rassi A Jr, Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, et al.Development and Validation of a Risk Score for Predicting Death in Chagas’ Heart Disease. New England Journal of Medicine. 2006;355:799–808. DOI: 10.1056/NEJMoa053241.
Marin-Neto JA, Rassi Jr A, Oliveira GMM, et al.SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease – 2023. Arquivos Brasileiros de Cardiologia. 2023;120(6):e20230269. DOI: 10.36660/abc.20230269.
Rassi A Jr, Rassi A, Rassi SG.Predictors of mortality in chronic Chagas disease: a systematic review of observational studies. Circulation. 2007;115:1101–1108. DOI: 10.1161/CIRCULATIONAHA.106.627265.
Senra T, Ianni BM, Costa ACP, Mady C, Martinelli-Filho M, Kalil-Filho R, Rochitte CE.Long-Term Prognostic Value of Myocardial Fibrosis in Patients With Chagas Cardiomyopathy. Journal of the American College of Cardiology. 2018;72(21):2577–2587. DOI: 10.1016/j.jacc.2018.08.2195.
Clinical disclaimer: This calculator supports prognostic risk stratification and does not establish a diagnosis or prescribe treatment. Interpret the result in the context of the patient's clinical condition and the original score's inclusion/exclusion criteria. The published mortality figures are cohort-level estimates and should not be presented as precise individual predictions. The 2023 SBC guideline notes that the score's usefulness for directing specific treatment decisions remains to be determined.
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