Reduced functional capacity in patients with Chagas disease: a systematic review with meta-analysis

Abstract

Reduced peak oxygen uptake (VO2peak) is a common clinical finding in progressive Chagas disease. However, the disease stage in which functional impairment is detectable remains uncertain. The present study compared functional capacity between healthy controls and patients with different clinical forms of Chagas disease. A systematic review and meta-analysis (PROSPERO database CRD42017058353) was conducted following a search of the MEDLINE, Web of Science, CINAHL, and LILACS databases from September to December 2017 for articles published in English, Spanish, or Portuguese, with no date restrictions. We included studies that compared the VO2peak between healthy and Chagas disease patients, stratified according to 3 clinical forms [no apparent cardiac disease, non-dilated Chagas heart disease (CHD), and dilated CHD]. Seven cross-sectional studies were included. Chagas disease patients without apparent cardiac disease (n=208) had VO2peak values [mean difference, -1.55ml/kg/min; 95% confidence interval (CI), -4.98ml/kg/min to 1.88ml/kg/min] similar to those of healthy controls (n=105; p=0.38, I2=52%). In non-dilated CHD (n=159), VO2peak was 8.71ml/kg/min lower (95% CI, -13.99 to -3.42ml/kg/min) than in healthy controls (n=59; p=0.001, I2=75%). VO2peak was also significantly lower (mean difference, -9.30ml/kg/min; 95% CI, -11.34 to -7.25ml/kg/min) in dilated CHD patients (n=131) than in healthy controls (n=53; p<0.001, I2=0%). Exercise capacity in Chagas disease patients without apparent cardiac disease is similar to that in healthy controls. Functional impairment in Chagas disease is detectable in the early stages of cardiac involvement, even in the absence of systolic dysfunction and signs of heart failure.

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

“…There were no restrictions on the year of publication until January 2020. This review did not include comparisons of functional capacity between healthy individuals and patients with ChC as a recent systematic review and meta-analysis 7 has already been performed.…”

“…A recent statement 6 standardized the terms Chagas cardiomyopathy (ChC) to define patients with cardiac involvement (electrocardiographic abnormality in patients with positive serological tests against Trypanosoma cruzi) and dilated ChC to describe patients with left ventricular enlargement with systolic dysfunction. However, patients with ChC, regardless of systolic function and degree of ventricular dilation, have impaired functional capacity 7 , which reinforces the need for evaluation by exercise tests. Even in asymptomatic patients, non-invasive methods such as conventional maximal exercise test and cardiopulmonary exercise testing (CPET) can detect significant changes, including exerciseinduced ventricular arrhythmias (EIVAs) 8 and chronotropic incompetence 9 .…”

Prevalence and determinants of depressive symptoms in patients with Chagas cardiomyopathy and predominantly preserved cardiac function

“…The disease is endemic in Latin America, with an increased prevalence in non-endemic countries such as the United States and some regions of Europe due to migration to these areas 7,8 . Among patients with this disease, 30% to 40% experience the cardiac form of the infection, which is characterized by constant inflammation, loss of cardiac muscle fibers, systolic dysfunction, functional impairment, and worse prognosis than other cardiopathies 9,10 , which in turn may be associated with mental torment and the onset of depressive symptoms 3,11 .…”

“…In patients with Chagas disease, most studies and clinicians have focused on the body structure and function components such as cardiac function 12,13 , myocardial dilation 14 , and functional capacity 10 . Despite the importance of the presence of depressive symptoms in Chagas disease and the impact of these symptoms on clinical management, few studies have investigated these symptoms.…”

Functional capacity in Chagas disease

“…In this issue, Costa et al 7 presented a study that contributes to our understanding of an important feature in Chagas disease, i.e., the existence (or not) of reduced functional capacity in different stages of the disease. Patients with dilated Chagas heart disease (CHD) undoubtedly have impaired functional capacity, but consensus is lacking about whether patients without apparent cardiopathy or with non-dilated CHD are similarly affected 7 . To answer this question, the authors performed a systematic review of studies that evaluated the measured or estimated peak oxygen consumption (VO 2 peak) in Chagas disease patients classified in at least one of these stages compared to that in a control group.…”