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

Henrique Silveira Costa,Maria Carmo Pereira Nunes,Fábio Silva Martins Da Costa,Márcia Maria Oliveira Lima,Ana Thereza Chaves,Manoel Otávio Da Costa Rocha,Pedro Henrique Scheidt Figueiredo

doi:10.1590/0037-8682-0158-2018

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.

Highlights

Chagas disease remains a serious public health problem in Latin American countries
The following strategy was used for the PubMed search— ["Chagas Disease"(Mesh) OR "Chagas heart disease" OR "Chagas Cardiomyopathy"(Mesh)] AND ["Exercise"(Mesh) OR "Exercise Test"(Mesh) OR "functional capacity" OR "oxygen consumption"(Mesh) OR "oxygen uptake" OR "VO2peak"]—and was modified for each database
After reading the full text, 16 articles were excluded for failing to meet the objective of the present review, 1 did not define the clinical form of patients with Chagas disease, 1 did not report the sample size, and 3 were by authors who evaluated the same group of study patients in already included studies

Summary

Introduction

Chagas disease remains a serious public health problem in Latin American countries. The Benznidazole Evaluation for Interrupting Trypanosomiasis trial (BENEFIT)[4] showed that parasiticidal treatment does not seem to reduce cardiac damage in Chagas heart disease (CHD), the most severe clinical form of the infection[5]. The stage of disease in which reduced functional capacity can be observed remains unclear. Other studies[11,12] reported that reduced functional capacity can be detected only in the advanced stage of the disease, with fatigue and dyspnea during ordinary physical activity as a well-defined marker of poor prognosis[13,14]

Methods

Results

Conclusion