Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

Abstract

Introduction:The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. Methods: A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. Results: Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. Conclusions: CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.

Reassessment of quality of life domains in patients with compensated Chagas heart failure after participating in a cardiac rehabilitation program

“…A recent study conducted by our group demonstrated important clinical benefits of an 8-month cardiac rehabilitation program on patients with Chagas heart failure, mainly in terms of cardiac function and respiratory muscle strength, with no improvement on overall health-related QOL using a diseasespecific instrument 10 . However, a comprehensive assessment taking the different QOL domains into account was not performed.…”

“…This is a secondary analysis of a single-arm pilot study that was designed to determine the safety and efficacy of a cardiac rehabilitation program in patients with Chagas heart failure. The full description and results of the primary analysis have been published 10 . In brief, 12 patients with Chagas cardiomyopathy stage C or D but with no history of clinical decompensations during the previous 3 months, were included in the study 11 .…”

“…The final score (range: 0-100) was calculated according to the recommendations of the SF-36 creators, with higher scores representing a better QOL. Patients included in the study also underwent evaluations of functional capacity (maximal cardiopulmonary exercise test) and cardiac function (two-dimensional echocardiography), as previously described 10 . All assessments were performed at baseline and after 8 months of follow-up.…”

Quality of life and associated factors in patients with chronic Chagas disease

“…Moreover, the survival of many more patients suffering from chronic diseases, mainly due to improvements in their treatment, has transformed the QoL into a therapeutic target . However, studies examining QoL among patients with Chagas disease and its associated factors are scarce .…”

Selected cardiac abnormalities in Trypanosoma cruzi serologically positive, discordant, and negative working dogs along the Texas-Mexico border

“…Chronic Chagas cardiomyopathy in humans can cause a decreased response to exercise and stress due to failure of cardiac compensation [61,62]. However, benefits of exercise training in chronic heart failure patients has been shown, and new research suggests that regular exercise could assist with cardiac function in chronic Chagas disease in humans [63,64]. A randomized trial comparing humans with chronic Chagas disease who underwent a 12-week exercise training program compared to those who did not, found that those who completed exercise training had improvements in oxygen uptake, exercise time, walking distance and heart rate peak [63].…”