ABSTRACT Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.

Resumo Fundamento: A doença de Chagas leva à redução da capacidade funcional. Entretanto, o estágio em que o comprometimento funcional é detectável permanece obscuro. Objetivos: O presente estudo teve como objetivo comparar a capacidade funcional de pacientes em diferentes estágios da doença de Chagas e de indivíduos saudáveis e verificar os determinantes do consumo de oxigênio de pico (VO2pico). Métodos: Em um estudo transversal, foram selecionados 160 indivíduos, 35 saudáveis e 125 com doença de Chagas. No grupo chagásico, 61 (49%) estavam na forma indeterminada da doença, 45 (36%) com cardiomiopatia chagásica (CC) e função cardíaca preservada e 19 (15%) com disfunção cardíaca e CC dilatada. Os dados foram analisados por meio de análise de regressão univariada e multivariada. A significância estatística foi fixada em 5%. Resultados: Pacientes na forma indeterminada da doença apresentaram capacidade funcional semelhante a indivíduos saudáveis (p> 0,05). Pacientes com ChC e função cardíaca preservada apresentaram VO2pico menor que os pacientes na forma indeterminada (p <0,05), mas apresentaram valores de VO2pico semelhantes ao ChC dilatado (p = 0,46). A idade, sexo masculino, classe funcional da NYHA, pressão arterial diastólica, razão entre a velocidade do fluxo transmitral diastólico precoce e a velocidade anular mitral diastólica precoce, a fração de ejeção do ventrículo esquerdo (FEVE) e o diâmetro diastólico final do ventrículo esquerdo foram associados à capacidade funcional. Porém, apenas idade, sexo masculino, FEVE e classe funcional da NYHA permaneceram associados ao VO2pico no modelo final (R2 ajustado = 0,60). Conclusão: Pacientes com CC apresentam menor capacidade funcional do que pacientes na forma indeterminada. FEVE, idade, sexo masculino e classe funcional da NYHA foram determinantes do VO2pico em pacientes com doença de Chagas.

Abstract Background: Chagas disease leads to reduced functional capacity. However, the stage at which functional impairment is detectable remains unclear. Objectives: The present study was addressed to compare the functional capacity of patients at different stages of Chagas disease and healthy individuals and to verify the determinants of peak oxygen uptake (VO2peak). Methods: In a cross-sectional study, 160 individuals were selected, 35 healthy and 125 with Chagas disease. In the Chagasic group, 61 (49%) were in the indeterminate form of the disease, 45 (36%) with Chagas cardiomyopathy (ChC) and preserved cardiac function and 19 (15%) with cardiac dysfunction and dilated ChC. The data were analyzed using univariate and multivariate regression analysis. Statistical significance was set at 5%. Results: Patients in the indeterminate form of disease showed similar functional capacity to healthy individuals (p>0.05). Patients with ChC and preserved cardiac function had lower VO2peak than patients in the indeterminate form (p<0.05), but showed similar VO2peak values than dilated ChC (p=0.46). The age, male sex, NYHA functional class, diastolic blood pressure, ratio of the early diastolic transmitral flow velocity to early diastolic mitral annular velocity, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter were associated with functional capacity. However, only age, male sex, LVEF and NYHA functional class, remained associated with VO2peak in the final model (adjusted R2=0.60). Conclusion: Patients with ChC had lower functional capacity than patients in the indeterminate form. LVEF, age, male sex and NYHA functional class were determinants with VO2peak in patients with Chagas disease.

Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

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.

Introdução O tabagismo é uma das principais causas de morbimortalidade em todo o mundo. Indivíduos fumantes têm risco aumentado de desenvolver disfunção autonômica, a qual pode ser avaliada tanto pela variabilidade da frequência cardíaca (VFC) como pela frequência cardíaca de recuperação (FCRec). A maioria dos estudos envolvendo esta análise é realizada em adultos de idade avançada e na condição de repouso. Objetivos Comparar a atividade autonômica cardíaca em repouso e esforço, em homens jovens, fumantes e não fumantes. Métodos Trinta e dois jovens voluntários, (idade 22,0 ± 2,8 anos) foram distribuídos em dois grupos: o grupo fumante (GF; n=15) e o não fumante (GNF; n=17). Realizou-se o teste de Cooper, com análise da VFC pelo cardiofrequencímetro Polar(r)s810i, em repouso e durante o esforço e FCRec. Resultados No GF, 73% foram classificados com nível de dependência nicotínica "muito baixa" segundo questionário de Fargeström. A classificação de ativos e muito ativos pelo questionário IPAQ correspondeu a mais de 50% da amostra em ambos os grupos. Não se observou diferenças significativas entre os grupos na VFC, tanto no repouso quanto no esforço. Entretanto, em cada grupo, notou-se diferença na maioria dos índices de VFC do repouso para o esforço. No teste de Cooper não foram observadas diferenças significativas na FCmédia, FCpico e de FCRec entre os grupos, mas notou-se uma melhor capacidade funcional no GNF pela distância caminhada (2050,2 ± 300,0 vs. 1780,3 ± 390,4 m, p=0,036). Conclusão O GF apresentou menor capacidade funcional e ativação parassimpática durante o esforço, além de menores índices de VFC durante repouso, o que pode sugerir um comprometimento precoce na modulação autonômica cardíaca.

Introduction Smoking is one of the major causes of morbidity and mortality worldwide. Smokers have an increased risk of developing autonomic dysfunction, which can be evaluated by both heart rate variability (HRV) and heart rate recovery (HRRec). Most studies involving this analysis is performed on adults of advanced age and in condition of rest. Objectives To compare the cardiac autonomic activity, at rest and during exercise in young men, smokers and non-smokers. Methods Thirty-two young volunteers (aged 22.0 ± 2.8 years) were divided into two groups: the smoking group (SG, n = 15) and non-smokers (NSG, n = 17). We carried out the Cooper test and HRV analysis by heart rate monitor Polar(r)s810i, at rest and during exercise and HRRec. Results In SG, 73% were classified as having a "very low" level of nicotine dependence according to the Fargeström's questionnaire. Classification of active and very active by the IPAQ questionnaire accounted for over 50% of sample in both groups. There were no significant differences between groups in HRV, both at rest and during exercise. However, in each group, difference has been noted in most HRV indexes from rest to exercise. During Cooper test there were no significant differences in mean HR, HRpeak and HRRec between groups, but a better functional capacity was noted in NSG in the distance walked (2050.2 ± 300.0 vs. 1780.3 ± 390.4m, p = 0.036). Conclusion The SG showed lower functional capacity and parasympathetic activation during exercise, besides lower HRV indexes during rest, suggesting an early impairment in cardiac autonomic modulation.

Introducción El consumo de cigarrillos es una de las más importantes causas de morbilidad y mortalidad en todo el mundo. Los individuos fumadores tienen mayor riesgo de desarrollar disfunción autonómica, que puede ser evaluada tanto por la variabilidad del ritmo cardíaco (VRC) como por la frecuencia cardiaca de recuperación (FCrec). La mayoría de los estudios con estos análisis se lleva a cabo en las personas más viejas y en situación de reposo. Objetivos Comparar la actividad autonómica cardiaca, en momento de reposo y durante ejercicios, en hombres jóvenes, fumadores y no fumadores. Métodos Treinta y dos voluntarios jóvenes (edad 22,0 ± 2,8 años) fueron divididos en dos grupos: grupo de fumadores (GF; n = 15) y no fumadores (GNF; n = 17). Se realizó la prueba de Cooper con el análisis de la VRC por pulsómetro Polar(r)s810i, durante reposo y ejercicio y FCrec. Resultados En el GF, el 73% fueron clasificados con niveles de dependencia por la nicotina "muy bajo", según cuestionario Fargeström. La clasificación de activos y muy activos, mediante cuestionario IPAQ, correspondió a más de 50% de la amuestra en ambos los grupos. No hubo diferencia significativa entre los grupos en la VRC, tanto en reposo cuanto en ejercicio. Sin embargo, en cada grupo, observamos una diferencia en la mayoría de los índices de VRC del reposo para el ejercicio. En la prueba de Cooper no se observó diferencias significativas en las FC media, FCpico y FCrec, pero se verificó una mejor capacidad funcional en el GNF por la distancia caminada (2050.2 ± 300.0 vs. 1780,3 ± 390,4 m, p = 0,036). Conclusión El GF mostró una capacidad funcional y una activación parasimpática más baja durante el ejercicio, así como tasas más bajas de VRC en reposo, lo que puede sugerir un deterioro temprano en la modulación autonómica cardíaca.

Chagas disease (ChD), a neglected tropical disease caused by infection with the parasite Trypanosoma cruzi (T. cruzi), remains a serious public health issue in Latin America and is an emerging disease in several non-endemic countries, where knowledge of the condition and experience with its clinical management are limited. Regionally, the disease is the major cause of disability secondary to tropical diseases in young adults. Health-related quality of life (HRQoL) impairment is common in patients with ChD, especially in those with Chagas dilated cardiomyopathy, the most severe manifestation of the disease, which frequently leads to heart failure. The aim of this review was to conduct a literature search for studies that have evaluated the determining factors of HRQoL in ChD patients. We included cross-sectional, case-control, cohort, and experimental studies, as well as clinical trials that evaluated the HRQoL in ChD patients aged 18 to 60 years and are presenting an explicit description of statistical analysis. Using a combination of keywords based on Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH) for searches in PubMed and the Scientific Electronic Library Online (SciELO), 148 studies were found. After exclusions, 12 studies were selected for analysis. Three main findings were extracted from these studies: 1) cardiac involvement is associated with a worse HRQoL in ChD patients; 2) HRQoL is associated with the patients' functional capacity; and 3) simple and inexpensive therapeutic measures are effective for improving HRQoL in ChD patients. Hence, ChD patients' functional capacity, the effectiveness of non-surgical conservative treatment, and cardiac involvement are important determining factors for the HRQoL in ChD patients.

Fundamento: A variabilidade da frequência cardíaca (VFC) é marcador de gravidade da disfunção autonômica. Os efeitos do treinamento físico sobre índices de VFC na miocardiopatia chagásica (MPC) não são bem estabelecidos. Objetivo: Avaliar as mudanças nestes índices em resposta ao treinamento físico na MPC. Métodos: Pacientes com MPC e disfunção do ventrículo esquerdo (VE), fisicamente inativos, foram aleatorizados para os grupos intervenção (GI, N = 18) e controle (GC, N = 19). O GI participou de um programa de exercícios de 12 semanas, três sessões/semana. Resultados: A idade média foi de 49,5 ± 8 anos, 59% homens, FEVE de 36,3 ± 7,8%. Índices basais de VFC foram similares. Do basal ao seguimento, observamos no GI aumento da potência total (TP): 1.653 (IQ 625 - 3.418) para 2.794 (1.617 - 4.452) ms, p = 0,02) e potência de frequência muito baixa: 586 (290 - 1.565) para 815 (610 - 1.425) ms, p = 0,047), mas não no GC. A variação (pós/pré) dos índices de VFC foi similar: SDNN 11,5 ± 30,0 vs. 3,7 ± 25, 1 ms, p = 0,10; rMSSD 2 (6 - 17) vs. 1 (21 - 9) ms, p = 0,43; TP 943 (731 - 3.130) vs. 1.780 (921 - 2.743) Hz, p = 0,46 e potência de frequência baixa (LFP) 1,0 (150 - 197) vs. 60 (111 - 146) Hz, p = 0,85, exceto pela potência de alta frequência, que teve tendência a aumento no GI: 42 (133 - 92) vs. 79 (61 - 328) Hz, p = 0,08). Conclusão: Na população estudada, a variação dos índices de VFC foi similar entre os grupos ativo e inativo. A melhora clínica com o treinamento físico parece ser independente de marcadores de disfunção autonômica na MPC.

Background: Heart rate variability (HRV) is a marker of autonomic dysfunction severity. The effects of physical training on HRV indexes in Chagas heart disease (CHD) are not well established. Objective: To evaluate the changes in HRV indexes in response to physical training in CHD. Methods: Patients with CHD and left ventricular (LV) dysfunction, physically inactive, were randomized either to the intervention (IG, N = 18) or control group (CG, N = 19). The IG participated in a 12-week exercise program consisting of 3 sessions/week. Results: Mean age was 49.5 ± 8 years, 59% males, mean LVEF was 36.3 ± 7.8%. Baseline HRV indexes were similar between groups. From baseline to follow-up, total power (TP): 1653 (IQ 625 - 3418) to 2794 (1617 - 4452) ms, p = 0.02) and very low frequency power: 586 (290 - 1565) to 815 (610 - 1425) ms, p = 0.047) increased in the IG, but not in the CG. The delta (post - pre) HRV indexes were similar: SDNN 11.5 ± 30.0 vs. 3.7 ± 25.1 ms. p = 0.10; rMSSD 2 (6 - 17) vs. 1 (21 - 9) ms. p = 0.43; TP 943 (731 - 3130) vs. 1780 (921 - 2743) Hz. p = 0.46; low frequency power (LFP) 1.0 (150 - 197) vs. 60 (111 - 146) Hz. p = 0.85; except for high frequency power, which tended to increase in the IG: 42 (133 - 92) vs. 79 (61 - 328) Hz. p = 0.08). Conclusion: In the studied population, the variation of HRV indexes was similar between the active and inactive groups. Clinical improvement with physical activity seems to be independent from autonomic dysfunction markers in CHD.

OBJETIVO: Avaliar o efeito do treinamento com exercício aeróbio na capacidade funcional (CF) e no controle da pressão arterial (PA), em mulheres na pós-menopausa, hipertensas estágio I, controladas ou não com tratamento medicamentoso, em uma Unidade Básica de Saúde (UBS). METODOLOGIA: Antes e após 12 semanas de treinamento com exercício aeróbio em uma UBS, dez mulheres hipertensas na pós-menopausa, idade de 56,9 ± 6 anos, sedentárias, não usuárias de terapia de reposição hormonal, foram submetidas à avaliação do índice de massa corporal (IMC); da circunferência da cintura (CC); da CF pelo teste ergométrico (maior consumo de oxigênio/ VO2 e tempo de teste) e teste de caminhada em seis minutos (distância caminhada); e das medidas casuais repetidas da PA. Reavaliações foram efetuadas a cada 30 dias. Os dados são expressos em média e desvio-padrão. Foram aplicados os testes de Kolmogorov-Smirnov, t de Student pareado, Wilcoxon e ANOVA para medidas repetidas, considerando significativo p < 0,05. RESULTADOS: Não houve diferença significativa no IMC (p = 0,40) e CC (p = 0,74) após a intervenção. Entretanto, após 30 dias observou-se redução da PA sistólica (de 142,70 ± 6,25 para 130,76 ± 5,80 mmHg, p < 0,001) e diastólica (de 87,03 ± 4,48 para 81,90 ± 4,30 mmHg, p = 0,002) e melhora da CF pelo VO2 (de 24,90 ± 6,38 para 27,82 ± 6,14 mL/kg/min, p = 0,028), tempo de teste (de 6,89 ± 1,78 para 7,7 ± 1,8 min, p = 0,022) e distância caminhada (de 511,07 ± 41,99 para 556,1 ± 43,19 m, p = 0,009). CONCLUSÃO: O programa de treinamento com exercício aeróbio em uma UBS mostrou-se efetivo e viável, contribuindo para a redução da PA e melhora da capacidade funcional em mulheres hipertensas na pós-menopausa.

OBJECTIVE: To evaluate the effect of the aerobic exercise training on functional capacity (FC) and blood pressure (BP) control in hypertensive stage I or controlled hypertension postmenopausal women in a primary care unit (PCU). METHODS: Before and after 12 weeks of aerobic exercise training in a PCU, 10 hypertensive postmenopausal women age 56.9 ± 5.98, sedentary, non-users of hormone replacement therapy were submitted to: the evaluation of the body mass index (BMI); the waist circumference (WC); the FC by ergometric test (oxygen uptake/VO2, duration of the test) and six minute walk test (walked distance); and repeated casual measures of BP. Revaluations were made for each 30 days. Data were presented in mean and standard deviation and analyzed by Kolmogorov-Smirnov test, paired Student's t-test, Wilcoxon and a repeated-measures ANOVA considering p < 0.05. RESULTS: No significant difference was found in BMI (p = 0.40) and WC (p = 0.74) after training. However, after 30 days, a reduction had already been observed in systolic BP (from 142.70 ± 6.25 to 130.76 ± 5.80 mmHg, p < .001) and diastolic (from 87.03 ± 4.48 to 81.90 ± 4.30 mmHg, p = .002) and also a significant improvement of functional capacity by VO2 (from 24.90 ± 6.38 to 27.82 ± 6.14 mL/kg/min, p = .028), duration of the test (from 6.89 ± 1.78 to 7.70 ± 1.80 min, p = .022) and distance walked (from 511.07 ± 41.99 to 556.1 ± 43.19 m, p = .009). CONCLUSION: The aerobic exercise training program in a primary care unit was effective and viable as a strategy to reduce the BP and to improve the functional capacity in hypertensive postmenopausal women.

A transverse study carried out in the years of 1995 and 2000. The aim was to describe a specific population in Diamantina, according to some predisposing high blood pressure factors. The variables studied were: high blood pressure, gender, age, race, smoking and drinking habits. The frequency of high blood pressure in 1995 was of 44,77% and 33,66% in 2000, being higher among men, in black people and increasing as they grow older. High blood pressure was found to be highest in the smoking and/or drinking habits group in 1995. However, in 2000, the highest blood pressure was found among the non-smoking and non-drinking group.

Se trata de un estudio transversal efectuado entre 1995 y 2000con miras a caracterizar una población específica de Diamantina con relación a algunos factores que predisponen para la hipertensión arterial. Se evaluaron las variables hipertensión arterial, sexo, edad, raza, adicción al tabaco y al alcohol. La frecuencia de presión arterial elevada (PAE) en 1995 fue de un 44,77% y en 2000 del 33,66%, mayor entre los hombres, en la raza negra y aumenta con la edad. En cuanto a la adicción al tabaco y/o alcohol, en 1995 los niveles más altos de presión arterial se detectaron en dicho grupo y en 2000 la PAE se manifestó más en individuos no fumadores y no alcohólicos.

Estudo transversal realizado nos anos de 1995 e 2000. Objetivou-se caracterizar uma população específica de Diamantina, em relação a alguns fatores predisponentes para Hipertensão Arterial. As variáveis avaliadas foram: pressão arterial, sexo, idade, raça, tabagismo e etilismo. A freqüência de Pressão Arterial Elevada (PAE) foi em 1995 de 44,77%, e em 2000 de 33,66%, sendo maior entre os homens; na raça negra e crescente com a idade. Em relação ao tabagismo e/ou etilismo, em 1995 os maiores níveis pressóricos foram detectados neste grupo, e em 2000 a PAE foi mais presente nos indivíduos não tabagistas e/ou etilistas