TABLE 3: Functional and prognostic evaluation in patients with ChC by field tests (n=10).
| STUDY | POPULATION | EXERCISE TESTS | RESULTS |
|---|---|---|---|
| Sousa et al. (2008) 50 | 38 patients with dilated ChC, 48±10 years; 68% male; NYHA I-III, LVEF<55% | 6MWT | The 6MWT distance was correlated with MCP-1 values (r=−0.358, p=0.04), BNP levels (r=−0.349, p=0.04), and LVEF (r=0.451, p=0.004) but not with NYHA functional class (r=−0.130, p=0.435). |
| Dourado et al. (2010) 51 | 60 patients with ChC: 55±14 years; 68% male; 25% in NYHA III-IV; LVEF: 44.0±13.8% and 38 patients with ChC and systemic arterial hypertension: 63±10 years; 88% male; 21% in NYHA III-IV; LVEF: 51.8±12.9% | 6MWT | No difference in 6MWT distance between groups with and without systemic arterial hypertension (p>0.05). In the systemic arterial hypertension group, the 6MWT distance was correlated with MLwHFQ (r=-0.51; p=0.001). In the group without systemic arterial hypertension, the 6MWT distance was correlated with hemoglobin levels (r=0.34; p=0.007) and MLwHFQ (r= -0.38; p=0.003). |
| Ritt et al. (2013) 13 | 55 patients with dilated ChC (52±9 years, 69% male, NYHA II-IV, LVEF: 27.6±6.6%). Follow-up period: 32±19 months; endpoint: cardiac death | CPET (ramp protocol, treadmill) and 6MWT | The 6MWT was correlated with MLwHRQ (r=-0.375; p=0.007) and was the only independent determinant of MLwHRQ (each 10-min increase in distance walked was associated with a 0.7-point reduction in MLHFQ score); no prognostic value. |
| Costa et al. (2014) 56 | 35 patients (dilated and preserved LVEF), 47.1±8.2 years, 66% male, NYHA I-III and LVEF: 59 (41-64)% | CPET (ramp protocol, treadmill) and ISWT | ISWT distance was correlated with VO2peak (r=0.587; p<0.001), MLwHRQ score (r=-0.460; p=0.006), and SF-36 domains physical functioning (r=0.435; p=0.009), role physical (r=0.447; p=0.008), and mental health (r=0.430; p=0.011). |
| Costa et al. (2014) 23 | 41 patients with ChC (dilated and with preserved LVEF), 47.8±8.3 years; 68% male; NYHA I-III | CPET (ramp protocol, treadmill) and 6MWT | Patients with dilated ChC showed lower 6MWT distance (p=0.045) compared to that in patients with preserved LVEF. The 6MWT distance was correlated with VO2peak (r=0.586; p<0.001) but not with VE/VCO2 slope (r=−0.046; p=0.776). The 6MWT distance was correlated with VO2peak in both dilated ChC (n=20, r=0.612; p=0.005) and preserved LVEF (n= 21, r=0.463; p=0.035) groups. |
| Alves et al. (2016) 55 | 32 patients with ChC (6 with dilated ChC and 26 with preserved LVEF), 58.8±9.0 years; 18.7% male; NYHA I-III, LVEF: 62.4±13.4% | CPET (Bruce protocol, treadmill) and ISWT | The ISWT distance was correlated with VO2peak (r=0.456; p=0.009). In women, the VO2peak was predicted by the formula 13.97 + 0.02 x ISWT distance (for NYHA I) or 11.36 + 0.02 x ISWT distance (for NYHA³II). In men, the VO2peak was predicted by the formula 12.21 + 0.03 x ISWT distance (for NYHA I) or 9.60 + 0.03 x ISWT distance (for NYHA³II). |
| Chambela et al. (2017) 53 | 40 patients with dilated ChC, 60±12 years; 47% male; NYHA I-III, LVEF: 35±12% | 6MWT | The 6MWT distance was correlated with BNP (r=-0.37; p=0.02) and echocardiographic features, including E velocity (r=-0.38; p=0.002), E/E’ ratio (r=-0.32; p=0.05), LV diastolic dysfunction (r=-0.36; p=0.03), mitral regurgitation (r= -0.53; p<0.001), and PASP (r=-0.42; p=0.02). The 6MWT distance was also correlated with the SF-36 domains physical functioning (r=0.46; p=0.008), physical role functioning (r=0.37; p=0.04), and bodily pain (r=0.43; p=0.014) as well as MLwHRQ (r=-0.54; p=0.002). |
| Costa et al. (2017) 26 | 81 patients with ChC (dilated and with preserved LVEF), 48.6±8.1 years; 63% male; NYHA I-III, LVEF: 43.7±13.7% | Maximal Exercise Test (treadmill) and 6MWT | The VO2peak was correlated with the 6MWT distance (r=0.527; p<0.001) and VO2peak was predicted by the formula 53.43 + (1.35 × sex) - (5.59 × NYHA) + (0.01 × 6MWT distance) - (0.29 × age) - (0.035 × BMI). |
| Costa et al. (2017) 54 | 60 patients with dilated ChC, 52.6±9.4 years; LVEF: 27.1±5.5%. Follow-up period: 7.5 years. Endpoint: death | 6MWT | The 6MWT was not a predictor of death. The independent predictors of death were non-sustained ventricular arrhythmias in 24h Holter monitoring and left atrium volume index (p<0.05 for both). |
| Costa et al. (2018) 49 | 35 patients with ChC (dilated and with preserved LVEF), 47.1±8.2 years; 66% male; NYHA I-III, LVEF: 59.0 [41.0-64.0] | CPET (ramp protocol, treadmill), 6MWT and ISWT | The VO2peak was correlated with 6MWT distance (r=0.577; p<0.001) and ISWT distance (r=0.587; p<0.001). Only the ISWT was correlated with the VE/VCO2 slope (r=-0.339; p=0.003). The optimal distances to identify patients with functional impairment were 520 m for the 6MWT and 400 m for the ISWT. |
Data presented as mean±standard deviation; median (25-75%); mean [95% CI] or percentage. Abbreviations: ChC: Chagas cardiomyopathy; NYHA: New York Heart Association; LVEF: left ventricular ejection fraction; 6MWT: six-minute walk Test; MLwHFQ: Minnesota Living with Heart Failure Questionnaire; CPET: Cardiopulmonary Exercise Testing; VO2peak: peak oxygen uptake; VE/VCO2 slope: minute ventilation/carbon dioxide production slope; HRQoL: health-related quality of life; SF-36: Short-form of Health Survey; ISWT: Incremental Shuttle Walk Test; BNP: brain natriuretic peptide; E velocity: peak early diastolic filling velocity; E/E´ ratio: ratio of the early diastolic transmitral flow velocity to early diastolic mitral annular velocity; PASP: pulmonary artery systolic pressure; AUC: area under the ROC curve; MCP-1: monocyte chemoattractant protein-1.