Exercise training improves microvascular function in patients with Chagas heart disease: Data from the PEACH study.

BACKGROUND: Chagas heart disease (CHD) impairs the systemic microvascular function. We investigated the effects of exercise training on cutaneous microvascular function among patients with CHD. METHODS: Patients from the PEACH study were randomly assigned to a supervised exercise training 3 times/week for 6 months (Trained; n = 10) or a control group (Untrained; n = 8). Both groups underwent evaluation of microvascular function before, and at 3- and 6-months of follow-up. Cutaneous vascular conductance (CVC) was assessed in the skin of the forearm using laser speckle contrast imaging coupled with iontophoresis of acetylcholine (ACh), sodium nitroprusside (SNP) and during post-occlusive reactive hyperemia (PORH). RESULTS: At 3-months of follow-up, no difference was detected between groups in CVC responses to ACh (p = 0.50), SNP (p = 0.26) and HRPO (p = 0.65). However, at 6-months of follow-up, trained vs. untrained patients improved CVC induced by SNP-iontophoresis (0.19 ± 0.10 vs. 0.14 ± 0.15 APU.mmHg-1; p = 0.05) and PORH (0.63 ± 0.15 vs. 0.48 ± 0.18 APU.mmHg-1; p = 0.05). CVC response to ACh-iontophoresis was similar between groups (0.19 ± 0.11 vs. 0.22 ± 0.17 APU.mmHg-1; p = 0.38). CONCLUSION: Exercise training performed during 6 months improved the cutaneous microvascular function of CHD patients. Further studies evaluating the mechanism involved in this response are warranted.

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

INTRODUCTION:: We evaluated the effects of a cardiac rehabilitation program on quality of life. METHODS: This secondary analysis of a single-arm study included 12 patients with Chagas heart failure. The cardiac rehabilitation program comprised exercise training and nutritional and pharmaceutical counseling. Quality of life was assessed using the SF-36 questionnaire. RESULTS:: The program promoted improved physical functioning (ß= +5.7; p=0.003), role-physical (ß= +1.9; p=0.03), and bodily pain (ß= +3.5; p=0.02) scores. Moreover, the summary physical health score (ß= +1.4; p=0.001) improved. CONCLUSION:: The cardiac rehabilitation program significantly improved the physical quality of life of patients with Chagas heart failure.

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

Abstract INTRODUCTION: We evaluated the effects of a cardiac rehabilitation program on quality of life. METHODS This secondary analysis of a single-arm study included 12 patients with Chagas heart failure. The cardiac rehabilitation program comprised exercise training and nutritional and pharmaceutical counseling. Quality of life was assessed using the SF-36 questionnaire. RESULTS: The program promoted improved physical functioning (β= +5.7; p=0.003), role-physical (β= +1.9; p=0.03), and bodily pain (β= +3.5; p=0.02) scores. Moreover, the summary physical health score (β= +1.4; p=0.001) improved. CONCLUSION: The cardiac rehabilitation program significantly improved the physical quality of life of patients with Chagas heart failure.

Abordagem das arritmias na Doença de Chagas Crônica / Approach of arrhythmias in chronic Chagas Disease

As arritmias na cardiopatia chagásica (CCH) são responsáveis por incapacitação física e morte em indivíduos adultos em faixa etária precoce e produtiva, decorrendo daí a necessidade de sua abordagem criteriosa e, às vezes, mais agressiva para se obter controle completo. As arritmias cardíacas mais encontradas na CCH são as bradiarritmias e as taquicardias. Entre as bradicardias estão as alterações sinoatriais e os bloqueios atrioventriculares, cujo tratamento padrão é o emprego de implante de marcapasso definitivo. Entre as taquiarritmias, encontram-se as supraventriculares ­ extrassístoles atriais, taquicardia atrial ectópica, "flutter" atrial e fibrilação atrial ­ que provocam morbidades como progressão para disfunção ventricular esquerda e fenômenos tromboembólicos, e as ventriculares, cujo desfecho pode ser a morte súbita instantânea. A abordagem deve ser, inicialmente, por meio de eletrocardiograma de 12 derivações, pela gravação ambulatorial (Holter), ecocardiograma, teste ergométrico, e por fim, o estudo eletrofisiológico e a ressonância nuclear magnética. O tratamento farmacológico pode ser conduzido com o uso dos fármacos existentes em nosso mercado, como amiodarona, propafenona e sotalol. O tratamento invasivo, pode consistir em ablação por cateter, embora com resultados ainda abaixo de índices confortadores, devido à possibilidade de recidivas. O uso de cardiodesfibrilador implantável é a última alternativa, que também tem suas limitações

Arrhythmias in Chagas cardiomyopathy (CCM) are responsible for physical disability and death in adults in early and productive age group, from which arises the need for a judicious and sometimes more aggressive approach to achieve the complete control. The arrhythmias most common in CCM are bradyarrhythmias and tachycardias. Among the bradycardias are the sinoatrial changes and atrioventricular blocks, whose standard treatment is the use of permanent pacemaker implantation. Among tachyarrhythmias are the supraventricular ones - atrial extrasystoles, ectopic atrial tachycardia, atrial flutter and atrial fibrillation - causing morbidity and progression of left ventricular dysfunction and thromboembolic events, and the ventricular ones, whose outcome can be the instantaneous sudden death. The approach should be initially through 12-lead electrocardiogram, by ambulatory ECG recording (Holter), echocardiogram, stress testing, and finally the electrophysiological study and magnetic resonance imaging. Pharmacological treatment can be conducted with the use of marketed drugs such as amiodarone, propafenone and sotalol. The invasive treatment may consist of catheter ablation, although the results are still below comforting rates due to the possibility of recurrence. The use of implantable cardioverter defibrillator is the last alternative, which also has its limitations

Effect of physical exercise training in patients with Chagas heart disease: study protocol for a randomized controlled trial (PEACH study).

BACKGROUND: The effects of exercise training on Chagas heart disease are still unclear. This study aimed to evaluate the effect of exercise training over functional capacity, cardiac function, quality of life, and biomarkers in Chagas heart disease. METHODS: The PEACH study is a superiority randomized clinical trial which will include subjects who meet the following criteria: Chagas heart disease with a left ventricular ejection fraction below 45 % with or without heart failure symptoms; clinical stability in the last 3 months; adherence to clinical treatment; and age above 18 years. The exclusion criteria are: pregnancy; neuromuscular limitations; smoking; evidence of non-chagasic heart disease; systemic conditions that limit exercise practice or cardiopulmonary exercise test; unavailability to attend the center three times a week during the intervention period; and practitioners of regular exercise. The intervention group will perform an exercise training intervention three times per week during 6 months and will be compared to the control group without exercise. Both groups will undergo the same monthly pharmaceutical and nutritional counseling as well as standard medical treatment according to the Brazilian consensus on Chagas disease. The primary outcome is functional capacity based on peak exercise oxygen consumption during cardiopulmonary exercise testing. Secondary outcomes are: cardiac function; body composition; muscle respiratory strength; microvascular reactivity; cardiac rhythm abnormalities; autonomic function; biochemical; oxidative stress and inflammatory biomarkers; and quality of life. Subjects will be evaluated at baseline, and at 3 and 6 months after randomization. Thirty patients will be randomly assigned into exercise or control groups at a ratio of 1:1. DISCUSSION: Findings of the present study will be useful to determine if physical exercise programs should be included as an important additional therapy in the treatment of patients with Chagas heart disease. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02517632 (registered on 6 August 2015).

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

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.

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.

Peak oxygen uptake during the incremental shuttle walk test in a predominantly female population with Chagas heart disease.

BACKGROUND: Chagas heart disease (CHD) patients may have a reduced functional capacity (FC). Field tests, as the Incremental Shuttle Walk Test (ISWT), can estimate peak oxygen uptake (VO2 peak). However, the relationship between the ISWT and the Cardiopulmonary Exercise Testing (CPET), the gold standard in the assessment of FC, is not well established in CHD patients. AIM: This study aimed to evaluate the FC of CHD patients by ISWT with direct measurement of VO2 peak and to compare these findings with data obtained from CPET. A secondary goal was to derive a regression equation to calculate the VO2 peak by ISWT. DESIGN: Cross-sectional and correlative study. SETTING: Research laboratory setting. POPULATION: Thirty-two CHD patients (58.8±9.0 years, 81.3% women) participated in this study. METHODS: Eligible patients underwent clinical evaluation, echocardiography, CPET by ramp protocol and ISWT according to current guidelines. RESULTS: The distance walked in ISWT showed a positive correlation with VO2 peak from CPET and ISWT (r=0.456, P=0.009 and r=0.869, P<0.001, respectively). In the agreement analysis, the values of the differences between VO2 peak from CPET and ISWT showed absence of bias (mean bias ±95% CI and mean -1.29±5.09 mL.kg.min). Based in real values of VO2 obtained from ISWT, one equation including sex, functional class and distance walked was provided to predict the VO2 values in this test. CONCLUSION: This study showed the good correlation between distance walked in ISWT and VO2 peak directly measured in both tests, and additionally, provided an equation to calculate a predictive VO2 peak by ISWT, suggesting a good alternative to evaluate the FC of CHD patients, especially in locations where sophisticated testing is not available. CLINICAL REHABILITATION IMPACT: The results confirm the possibility of using the ISWT for the evaluation of the FC in patients with CHD, especially in locations where sophisticated testing is not available.

Comparação da capacidade funcional de indivíduos chagásicos com fração de ejeção normal e diminuída / Comparison of the functional capacity of individuals with Chagas´Disease and normal fraction decreased

Indivíduos com cardiomiopatia chagásica eFração de Ejeção (FE) diminuída normalmente possuemlimitações à realização das atividades diárias e profissionais.No entanto, estudos mostram que a capacidade funcionaldesses pacientes medida pelo teste de esforço físico máximoconvencional é igual à de indivíduos chagásicos com FE normal.Objetivo: Mensurar a capacidade funcional, por meio do testecardiopulmonar, de indivíduos chagásicos com FE normal ediminuída. Métodos: Avaliados indivíduos com diagnósticolaboratorial de cardiomiopatia chagásica, sedentários, idadede 55 ± 3 anos, índice de massa corpórea de 25 ± 4 kg/m2. Aamostra foi dividida em dois grupos: Grupo Fração de EjeçãoNormal (GFEN) e Grupo Fração de Ejeção Diminuída (GFED).Todos os voluntários foram submetidos a ecocardiograma paradeterminar a FE e a um teste cardiopulmonar de rampa emesteira ergométrica para determinar o Volume de Oxigênio depico (VO2 pico). Resultados: Avaliados 14 indivíduos divididosigualmente entre os grupos. As médias e desvio padrão do VO2pico, respectivamente para GFEN e GFED, foram de 24 ± 10e 21 ± 6 ml/kg.min, não apresentando diferença estatísticasignificante (p = 0,745). Conclusão: Os resultados sugeremnão existir diferença entre a capacidade funcional de indivíduoschagásicos com FE normal ou diminuída, medida por meio doteste cardiopulmonar...

Introduction: Individuals with Chagas cardiomyopathy andejection fraction (EF) decreased, typically have limitations ondaily and professional activities. However, studies show that thefunctional capacity of these patients as measured by exercisestress test is equal to the maximum standard of chagasic patientswith normal EF. Objective: To measure the functional capacityby cardiopulmonary test of chagasic individuals with normal andreduced EF. Methods: We evaluated patients with laboratorydiagnosis of Chagas cardiomyopathy, sedentary, age 55 ± 3years, BMI 25 ± 4 kg/m2. The sample was divided into twogroups: Normal Ejection Fraction Group (NEFG) and DecreasedEjection Fraction Group (DEFG). All volunteers underwent anechocardiogram to determine EF and cardiopulmonary exercisetesting on a treadmill ramp to determine the volume of peakoxygen uptake (VO2 peak). Results: We evaluated 14 subjectsdivided equally between the groups. Mean and standard deviationof VO2 peak respectively for NEFG and DEFG were 24 ± 10:21 ±6 ml/kg min showing no statistically significant difference (p =0.745). Conclusion: The results suggest there is no differencebetween the functional capacity of individuals with Chagas FEnormal or decreased, as measured by cardiopulmonary exercisetesting...

Effects of an exercise program on blood pressure in patients with treated hypertension and chronic Chagas' heart disease / Efeitos de um programa de exercícios na pressão arterial de pacientes com hipertensão controlada e cardiopatia chagásica crônica

INTRODUCTION: Previous studies describe an imbalance of the autonomic nervous system in Chagas' disease causing increased sympathetic activity, which could influence the genesis of hypertension. However, patients undergoing regular physical exercise could counteract this condition, considering that exercise causes physiological responses through autonomic and hemodynamic changes that positively affect the cardiovascular system. This study aimed to evaluate the effects of an exercise program on blood pressure in hypertensive patients with chronic Chagas' heart disease. METHODS: We recruited 17 patients to a 24-week regular exercise program and used ambulatory blood pressure monitoring before and after training. We determined the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) from the beginning to the end of the study. RESULTS: The blood pressures were evaluated in general and during periods of wakefulness and sleep, respectively: SBP (p = 0.34; 0.23; 0.85), DBP (p = 0.46; 0.44; 0.94) and MBP (p = 0.41; 0.30; 0.97). CONCLUSIONS: There was no statistically significant change in blood pressure after the 24-week exercise program; however, we concluded that physical training is safe for patients with chronic Chagas' disease, with no incidence of increase in blood pressure.

INTRODUÇÃO: Estudos prévios descrevem um desequilíbrio do sistema nervoso autônomo na doença de Chagas causando maior atividade simpática, o que poderia influenciar na gênese da hipertensão arterial. No entanto, pacientes submetidos a exercícios físicos regulares poderiam contrapor esta condição, visto que o exercício provoca respostas fisiológicas através de adaptações autonômicas e hemodinâmicas que influenciam positivamente o sistema cardiovascular. O presente estudo se propõe a avaliar os efeitos da reabilitação cardíaca sobre a pressão arterial em pacientes hipertensos com cardiopatia chagásica crônica. MÉTODOS: Foram recrutados 17 pacientes submetidos a um programa regular de exercícios durante 24 semanas, sendo utilizado monitorização ambulatorial da pressão arterial (MAPA) antes e após o treinamento. Foi descrita a diferença da pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e pressão arterial média (PAM) do início ao fim estudo. RESULTADOS: As pressões foram avaliadas de forma geral e nos períodos de vigília e sono, respectivamente: PAS (p=0,34; 0,23; 0,85), PAD (p=0,46; 0,44; 0,94) e PAM (p=0,41; 0,30; 0,97). CONCLUSÕES: Não houve diferença estatisticamente significativa na variação da pressão arterial após o período de reabilitação cardíaca de 24 semanas, no entanto, evidenciamos que o treinamento físico é seguro em pacientes com cardiopatia chagásica crônica, não ocorrendo aumento da pressão arterial.

Effects of an exercise program on the functional capacity of patients with chronic Chagas' heart disease, evaluated by cardiopulmonary testing.

INTRODUCTION: Despite all efforts to restrict its transmission, Chagas' disease remains a severe public health problem in Latin America, affecting 8-12 million individuals. Chronic Chagas' heart disease, the chief factor in the high mortality rate associated with the illness, affects more than half a million Brazilians. Its evolution may result in severe heart failure associated with loss of functional capacity and quality of life, with important social and medical/labor consequences. Many studies have shown the beneficial effect of regular exercise on cardiac patients, but few of them have focused on chronic Chagas' heart disease. METHODS: This study evaluated the effects of an exercise program on the functional capacity of patients with chronic Chagas' disease who were treated in outpatient clinics at the Evandro Chagas Institute of Clinical Research and the National Institute of Cardiology, Rio de Janeiro, Brazil. The exercises were performed 3 times a week for 1 h (30 min of aerobic activity and 30 min of resistance exercises and extension) over 6 months in 2010. Functional capacity was evaluated by comparing the direct measurement of the O2 uptake volume (VO2) obtained by a cardiopulmonary exercise test before and after the program (p < 0.05). RESULTS: Eighteen patients (13 females) were followed, with minimum and maximum ages of 30 and 72 years, respectively. We observed an average increase of VO(2peak) > 10% (p = 0.01949). CONCLUSIONS: The results suggest a statistically significant improvement in functional capacity with regular exercise of the right intensity.

Effects of an exercise program on the functional capacity of patients with chronic Chagas' heart disease, evaluated by cardiopulmonary testing / Efeitos de um programa de exercícios sobre a capacidade funcional de pacientes com cardiopatia chagásica crônica, avaliados por teste cardiopulmonar

INTRODUCTION: Despite all efforts to restrict its transmission, Chagas' disease remains a severe public health problem in Latin America, affecting 8-12 million individuals. Chronic Chagas' heart disease, the chief factor in the high mortality rate associated with the illness, affects more than half a million Brazilians. Its evolution may result in severe heart failure associated with loss of functional capacity and quality of life, with important social and medical/labor consequences. Many studies have shown the beneficial effect of regular exercise on cardiac patients, but few of them have focused on chronic Chagas' heart disease. METHODS: This study evaluated the effects of an exercise program on the functional capacity of patients with chronic Chagas' disease who were treated in outpatient clinics at the Evandro Chagas Institute of Clinical Research and the National Institute of Cardiology, Rio de Janeiro, Brazil. The exercises were performed 3 times a week for 1 h (30 min of aerobic activity and 30 min of resistance exercises and extension) over 6 months in 2010. Functional capacity was evaluated by comparing the direct measurement of the O2 uptake volume (VO2) obtained by a cardiopulmonary exercise test before and after the program (p < 0.05). RESULTS: Eighteen patients (13 females) were followed, with minimum and maximum ages of 30 and 72 years, respectively. We observed an average increase of VO2peak > 10% (p = 0.01949). CONCLUSIONS: The results suggest a statistically significant improvement in functional capacity with regular exercise of the right intensity.

INTRODUÇÃO: Mesmo com todos os esforços para interrupção de sua transmissão, a doença de Chagas permanece como grave problema de saúde pública na América Latina, onde atinge entre 8 e 12 milhões de indivíduos. A cardiopatia chagásica crônica, principal responsável pela elevada morbimortalidade da doença, chega a acometer mais de meio milhão de brasileiros. Sua evolução atinge estágios graves de insuficiência cardíaca com perda de capacidade funcional e qualidade de vida, com grande impacto social e médico-trabalhista. Muitos estudos demonstram o resultado benéfico da prática regular de exercícios em cardiopatas, porém, há escassez de investigações em cardiopatia chagásica. MÉTODOS: O presente estudo avaliou efeitos de um programa de exercícios sobre a capacidade funcional de dezoito pacientes (13 mulheres) com cardiopatia chagásica crônica, com idade entre 30 e 72 anos, atendidos nos ambulatórios do Instituto de Pesquisa Clínica Evandro Chagas e do Instituto Nacional de Cardiologia, na cidade do Rio de Janeiro. Os exercícios foram executados 3 vezes por semana, durante 1 hora (30 minutos de atividade aeróbica e 30 minutos de exercícios contra-resistência e alongamentos), ao longo de 6 meses, no ano de 2010. A avaliação da capacidade funcional foi realizada pela comparação da medida direta do VO2 obtido pelo Teste de Exercício Cardiopulmonar, antes e depois do programa. Para análise estatística foram utilizados testes T de Student pareado e de Wilcoxon. RESULTADOS: Os resultados mostram aumento médio do VO2pico acima de 10%(p=0,01949). CONCLUSÕES: Os resultados sugerem melhora significativa da capacidade funcional com prática regular de exercícios na população amostral.

Effects of an exercise program on blood pressure in patients with treated hypertension and chronic Chagas' heart disease.

INTRODUCTION: Previous studies describe an imbalance of the autonomic nervous system in Chagas' disease causing increased sympathetic activity, which could influence the genesis of hypertension. However, patients undergoing regular physical exercise could counteract this condition, considering that exercise causes physiological responses through autonomic and hemodynamic changes that positively affect the cardiovascular system. This study aimed to evaluate the effects of an exercise program on blood pressure in hypertensive patients with chronic Chagas' heart disease. METHODS: We recruited 17 patients to a 24-week regular exercise program and used ambulatory blood pressure monitoring before and after training. We determined the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) from the beginning to the end of the study. RESULTS: The blood pressures were evaluated in general and during periods of wakefulness and sleep, respectively: SBP (p = 0.34; 0.23; 0.85), DBP (p = 0.46; 0.44; 0.94) and MBP (p = 0.41; 0.30; 0.97). CONCLUSIONS: There was no statistically significant change in blood pressure after the 24-week exercise program; however, we concluded that physical training is safe for patients with chronic Chagas' disease, with no incidence of increase in blood pressure.

Health-related quality of life in Brazilian outpatients with Chagas and non-Chagas cardiomyopathy.

PURPOSE: To examine differences in demographic, clinical, and health-related characteristics of quality of life in heart failure patients with Chagas and non-Chagas cardiomyopathy in Brazil. METHODS: This observational study was carried out with 43 Brazilian out-patients with Chagas and 59 non-Chagas cardiomyopathy. RESULTS: No differences were evident between the 2 groups regarding age, sex, mean left-ventricular ejection fraction, and duration of follow-up. Compared with the non-Chagas group, patients with Chagas cardiomyopathy had a higher percentage of participants using artificial pacemakers (P < .001), more symptoms of heart failure as measured by New York Heart Association classes III and IV (P = .02), higher intakes of aspirin and warfarin, a higher use of artificial pacemakers because of bradycardia, and lower health-related quality of life in the Physical Functioning (P = .01) and Role Physical (P = .002) domains of the Medical Outcomes Study Short Form 36-Item Health Status Survey. CONCLUSION: Our study population was limited to one region endemic for Chagas disease in Brazil, and therefore findings need to be confirmed and should not be generalized to other populations without further research.

Rehabilitación cardiaca en pacientes Chagásicos con insuficiencia cardiaca / Chagasic cardiac rehabilitation in patients with heart failure

Introducción: La capacidad funcional de los pacientes Chagásicos con insuficiencia cardíaca crónica suele deteriorarse en forma significativa y progresiva. Los programas de rehabilitación cardiovascular, RHCV, han demostrado amplios beneficios en pacientes con otras cardiopatías y múltiples facotres de riesgo. Objetivo: Evaluar la mejoría de la capacidad funcional en pacientes portadores de Insuficiencia Cardíaca de etiología Chagásica, con un protocolo de RHCV durante un año. Material y métodos: Se incluyeron pacientes en clase funcional II de la NYHA. A todos los pacientes sé los evaluó con la prueba de caminata de 6 minutos, consumo de oxígeno máximo, VO2 max, en ml/kg/min, capacidad funcional, en equivalentes metabólicos, METS, escala de percepción de esfuerzo de Borg, índice de eficiencia miocárdica, IEM, y la fracción de eyección, FE. Estos parámetros se valoraron cada 3 meses y se comparó cada paciente contra sí mismo al cabo de un año. Resultados: Ingresaron 42 pacientes, 17 varones de 41 a 56 años, promedio 54; y 25 mujeres de 45 a 57 años, promedio de 51, en clase funcional II, cuya prueba de caminata de 6 minutos fue de 375 metros, V02 max 15-18, 4.28-5.14 METS, escala de Borg 4-5, IEM 0.82 y FE igual 0.35. Al finalizar el año, 30 pacientes completaron el programa de RHCV: pasaron de clase funcional I, prueba de caminata de 6 min mayor 375 metros, V02 max 20-25, 6-7 METS, escala de Borg 5-7, IEM 1,17 y FE igual 0.45. Conclusiones: La aplicación de un programa de rehabilitación en pacientes Chagásicos con insuficiencia cardiaca en clase funcional II, se tradujo en una mejoría de la capacidad funcional, evaluada por distintos índices. La realización del entrenamiento físico programado, en estos enfermos demostró resultados satisfactorios, con una adherencia importante al tratamiento.

Marcapasso na Doença de Chagas / Pacemaker and Chagas disease

A doença de Chagas é uma doença comum causada pelo Trypanosoma cruzi e transmitida por um vetor, Panstrongylus megistus ou Triatoma infestans. Ela ocorre como uma doença aguda generalizada em que o miocárdio é quase sempre envolvido, e em sua forma crônica as manifestações são predominantemente cardíacas. Caracteriza-se por diminuição do número de células ganglionares, além de desintegração dos cilindros axônios, podendo apresentar simultaneamente quadro inflamatório. Sua forma crônica é a mais importante encontrada nos países da América do Sul. Tem evolução lenta e progressiva por alguns anos, como resultado de um quadro agudo e repetidas agressões do parasita. O miocárdio apresenta-se com numerosas lesões microfaciais e degeneração muscular com infiltrados intersticiais, com muitas áreas de fibrose. Raramente o parasito está presente. Os achados clínicos da fase crônica caracterizam-se por fraqueza generalizada, palpitações, dispnéia aos esforços e cardiomegalia. Esses echados evidenciam uma insuficiência cardíaca congestiva em evolução. Síncope ocorre com frequência e pode ser decorrente de bloqueio cardíaco completo. Morte súbita ocorre com certa frequência. A carcterística especial dessa doença é a ocorrência de todas as formas de arritmias e especialmente distúrbios de condução do coração, como bradicardia, ritmo de escape, ritmo nodal, bloqueios parciais ou completos, extra-sístoles, bloqueio do ramo direito do hemibloqueio anterior esquerdo, que são as características eletrocardiográficas dessa doença. Por causa dessa gama de alterações no sistema de condução do coração que pode provocar morte súbita, o implante de marcapasso nesses pacientes torna-se um tópico importante na área de Cardiologia, nos dias de hoje