ABSTRACT Symptoms in post-COVID-19 patients who require hospitalization can persist for months, significantly affecting their health-related quality of life (HRQoL). Thus, the present study aimed to discuss the main findings regarding HRQoL in post-COVID-19 patients who required hospitalization. An electronic search was performed in the MEDLINE, EMBASE, CINAHL, Web of Science, LILACS, and Scopus databases, without date and language restrictions, until July 2021. Twenty-four articles were included in the analysis. It seems that HRQoL partially improved soon after hospital discharge, although the negative impact on HRQoL may persist for months. The physical and mental aspects are affected because patients report pain, discomfort, anxiety, and depression. The HRQoL of COVID-19 infected patients was worse than that of uninfected patients. Additionally, HRQoL seemed worse in patients admitted to the intensive care unit than in those who remained in the ward. Improvements in HRQoL after hospital discharge are independent of imaging improvement, and there seems to be no association between HRQoL after hospital discharge and disease severity on hospital admission. Many factors have been identified as determinants of HRQoL, with women and advanced age being the most related to worse HRQOL, followed by the duration of invasive mechanical ventilation and the need for intensive care. Other factors included the presence and number of comorbidities, lower forced vital capacity, high body mass index, smoking history, undergraduate education, and unemployment. In conclusion, these findings may aid in clinical management and should be considered in the aftercare of patients.

ABSTRACT Chagas disease (CD) is a neglected tropical disease associated with poverty in which patients are surrounded by stigma. These factors can contribute to reducing health-related quality of life (HRQoL). Therefore, a broad discussion of HRQoL in the CD population is required. This study aimed to discuss the main findings of HRQoL in patients with CD, focusing on the association between sociodemographic and lifestyle factors, echocardiographic and functional determinants, and the effect of non-invasive interventions on HRQoL. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed with no data or language restrictions. Twenty-two articles were included in this meta-analysis. In general, HRQoL is worse in patients with CD than in healthy individuals, particularly in the presence of cardiovascular and/or gastrointestinal symptoms. Sex, age, functional class, level of physical activity, healthy habits, and medications received could affect HRQoL. Among the echocardiographic and functional determinants, decreased systolic function seems to negatively affect HRQoL. No association with the peak oxygen uptake was observed in the maximal tests. By contrast, well-tolerated field tests with submaximal intensities were associated with HRQoL. Both pharmaceutical care and exercise training have a positive effect on the HRQoL of patients with Chagas cardiomyopathy, and the mental component can be a prognostic marker in this population. In conclusion, assessment of HRQoL can provide important information about the health status of patients with CD, and its use in clinical practice is warranted.

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 INTRODUCTION: The minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) is among the main prognostic factors of Chagas cardiomyopathy whose determinants remain unknown. METHODS: Seventy-eight patients with Chagas cardiomyopathy were evaluated using clinical assessment, cardiopulmonary exercise test, echocardiography, and International Physical Activity Questionnaire. RESULTS: Age, functional class, International Physical Activity Questionnaire score, and dilated cardiomyopathy with systolic dysfunction were independent determinants of VE/VCO2 slope, and these variables explained 63% of its variance. CONCLUSIONS: The VE/VCO2 slope was related to age, functional class, physical activity level, and dilated cardiomyopathy with systolic dysfunction in patients with Chagas cardiomyopathy.

FUNDAMENTO: A estimulação apical crônica do ventrículo direito pode ocasionar dessincronia ventricular e, secundariamente, alterações neuro-humorais e aumento da morbimortalidade cardíaca. OBJETIVO: Pesquisar dessincronia ventricular e seus efeitos sobre os níveis de BNP em pacientes com marca-passo estimulados cronicamente no ápice do ventrículo direito (VD). MÉTODOS: Estudo transversal com 85 pacientes com marca-passo uni ou bicameral, em classe funcional I e II da NYHA e fração de ejeção do ventrículo esquerdo (FEVE) > 35%. A avaliação de dessincronia foi realizada utilizando-se várias técnicas ecocardiográficas, incluindo o Tissue Synchronization Imaging (TSI), com análise dos 12 segmentos. O BNP foi dosado junto com o ecocardiograma, porém com o examinador cego. RESULTADOS: Quarenta e seis mulheres e 39 homens, com idade de 58 ± 12 anos, chagásicos (56%) e hipertensos controlados (62%), foram incluídos. A fração de ejeção do VE foi 52 ± 8% e a duração média do QRS de 139 ms (120-180 ms). O BNP mostrou-se alterado em 36,5% da amostra (ponto de corte de 60 pg/ml). Na análise multivariada de regressão linear, o BNP correlacionou-se com a idade (p = 0,024), FEVE (p < 0,0001) e tempo pré-ejetivo do VE (p = 0,009), que é índice de dessincronia intraventricular. CONCLUSÃO: Em pacientes com estimulação cardíaca convencional, estáveis clinicamente, a dessincronia intraventricular foi um preditor independente do aumento dos níveis de BNP, após ajuste pela idade e FEVE.

BACKGROUND: Long-term right ventricular apical pacing can cause ventricular dyssynchrony and, secondarily, neurohumoral alterations and increase in cardiac morbimortality. OBJECTIVE: To analyze ventricular dyssynchrony and its effects on BNP levels in patients with pacemakers and long-term right ventricular (RV) apex pacing. METHODS: Cross-sectional study of 85 patients with single or dual chamber pacemaker, NYHA functional class I or II and left ventricular ejection fraction (LVEF) > 35%. The dyssynchrony assessment was carried out using several echocardiographic techniques, including Tissue Synchronization Imaging (TSI), with the analysis of the 12 segments. BNP was measured at the same time when the echocardiogram was performed, but the examiner was blinded to the results. RESULTS: Forty-six women and 39 men, aged 58 ± 12 years, with Chagas' disease (56%) and controlled hypertensive individuals (62%), were included in the study. LVEF was 52 ± 8% and the mean QRS duration was 139 ms (120-180 ms). BNP levels were altered in 36.5% of the sample (cutoff = 60 pg/ml). At the multivariate linear regression analysis, BNP was correlated with age (p = 0.024), LVEF (p < 0.0001) and left ventricular (LV) pre-ejection time (p = 0.009), which is an intraventricular dyssynchrony index. CONCLUSION: In clinically stable patients receiving conventional cardiac pacing, the intraventricular dyssynchrony was an independent predictor of BNP level increase after adjusted for age and LVEF.

FUNDAMENTO: La estimulación apical crónica del ventrículo derecho puede ocasionar disincronía ventricular y, secundariamente, alteraciones neurohumorales y aumento de la morbimortalidad cardíaca. OBJETIVO: Investigar disincronía ventricular y sus efectos sobre los niveles de BNP en pacientes con marcapasos estimulados crónicamente en el ápice del ventrículo derecho (VD). MÉTODOS: Estudio transversal con 85 pacientes con marcapasos uni o bicameral, en clase funcional I y II de la NYHA y fracción de eyección del ventrículo izquierdo (FEVI) > 35%. La evaluación de disincronía fue realizada utilizando varias técnicas ecocardiográficas, incluyendo el Tissue Synchronization Imaging (TSI), con análisis de los 12 segmentos. El BNP fue dosado junto con el ecocardiograma, aunque con el examinador ciego. RESULTADOS: Cuarenta y seis mujeres y 39 hombres, con edad de 58 ± 12 años, chagásicos (56%) e hipertensos controlados (62%), fueron incluidos. La fracción de eyección del VI fue 52 ± 8% y la duración media del QRS de 139 ms (120-180 ms). El BNP se mostró alterado en 36,5% de la muestra (punto de corte de 60 pg/ml). En el análisis multivariado de regresión lineal, el BNP se correlacionó con la edad (p = 0,024), FEVI (p < 0,0001) y tiempo pre-eyectivo del VI (p = 0,009), que es índice de disincronía intraventricular. CONCLUSIÓN: En pacientes con estimulación cardíaca convencional, estables clínicamente, la disincronía intraventricular fue un predictor independiente del aumento de los niveles de BNP, después de ajuste por edad y FEVI.

OBJETIVO: Avaliar a utilização do teste de estresse ostostático ativo na detecção de disfunção vagal em chagásicos com função sistólica global preservada, comparando-o ao teste da arritmia sinusal respiratória. MÉTODO: Foram selecionados 61 chagásicos (Ch) e 38 não-chagásicos (NCh) sem evidências significativas de cardiopatia ou doenças sistêmicas, submetidos ao ecodopplercardiograma e às provas autonômicas. O teste da arritmia sinusal respiratória foi realizado através do registro eletrocardiográfico enquanto o paciente respirava profundamente, a 6 irpm, calculando-se a razão E:I (média das razões entre os maiores intervalos RR expiratórios e os menores RR inspiratórios a cada ciclo). O eletrocardiograma foi registrado enquanto o paciente se levantava e nos 30s seguintes (teste do estresse ortostático ativo), calculando-se a razão RR máx./RR min (maior e menor intervalo RR logo após a mudança postural). Os índices foram ajustados para covariáveis significativas. RESULTADOS: A razão RR max:min (NCh: 1,52 [1,44-1,74] x Ch: 1,43 [1,33-1,51], p < 0,001) e a razão E:I (NCh: 1,38±0,02 x Ch: 1,25±0,02, p<0,001) foram menores entre os chagásicos. Houve elevada correlação entre a razão RR max:min e a razão E:I ajustadas (r = 0,628, p < 0,001), mas ambas não se correlacionaram significativamente com a fração de ejeção do ventrículo esquerdo. CONCLUSÃO: Chagásicos com função sistólica global do ventrículo esquerdo preservada apresentam redução significativa de índices vagais obtidos por provas curtas, quando comparados a controles normais. O teste de estresse ortostático ativo apresentou boa correlação com a manobra de arritmia sinusal respiratória, constituindo-se opção válida na avaliação ambulatorial do controle vagal.

OBJECTIVE: To assess the use of the active orthostatic stress test for detecting vagal dysfunction in patients with Chagas' disease with preserved overall systolic function, and to compare it with the respiratory sinus arrhythmia test. METHODS: Sixty-one chagasic patients (Ch) and 38 nonchagasic (NCh) patients with no significant evidence of heart disease or systemic diseases underwent Doppler echocardiography and autonomic function tests. The respiratory sinus arrhythmia test was performed through electrocardiographic recording during deep breathing, at 6 ripm, calculating the E:I ratio (mean ratio between the longest expiratory RR interval and the shortest inspiratory RR interval at each cycle). The electrocardiogram was recorded during the act of standing and during the following 30 seconds (active orthostatic stress test), and the max RR/min RR ratio (the longest and shortest RR intervals right after change in posture) was calculated. The indices were adjusted for significant covariables. RESULTS: The max RR/min RR ratio (NCh: 1.52 [1.44-1.74] x Ch: 1.43 [1.33-1.51], P < 0.001) and the E:I ratio (NCh: 1.38±0.02 x Ch: 1.25±0.02, P<0.001) were lower among chagasic patients. A high correlation was observed between the adjusted max RR/min RR ratio and E:I ratio (r = 0.628, P < 0.001), but neither significantly correlated with left ventricular ejection fraction. CONCLUSION: Chagasic patients with preserved left ventricular overall systolic function showed a significant reduction in the vagal indices obtained on short-lasting tests, as compared with normal controls. The active orthostatic stress test that, showed a good correlation with the respiratory sinus arrhythmia maneuver, constituted a valid option for the outpatient care assessment of vagal control.

Este trabalho tem como objetivo verificar o grau e tipo de comprometimento orgânico-funcional cardíaco dos pacientes chagásicos idosos e compará-los com as alterações evidenciadas por chagásicos jovens com grau semelhante de dano miocárdico. Verificou-se que idosos sem cardiopatia avançada apresentaram bom comportamento funcional, semelhante ao dos jovens do mesmo estádio clínico. Idosos com formas avançadas apresentaram mais extra-sistolia ventricular ao Holter e menor capacidade funcional à ergometria que jovens do mesmo sub-grupo. Houve maior ocorrência de ESV esforço-induzida e menor prevalência de formas graves nos homens idosos, sugerindo evidências de pior evolução da doença de Chagas no sexo masculino. A associação de alterações cardíacas próprias do envelhecimento ao dano secundário à doença de Chagas poderia explicar o maior comprometimento funcional encontrado em idosos. Assim, os componentes fisiopatológicos da doença de Chagas parecem influenciar a evolução da cardiopatia na população idosa.

The objective of this work was to verify the degree and type of heart damage of elderly chagasic patients seen at an outpatient referral center and to compare them with the changes found in young chagasic patients with a similar degree of heart damage. Elderly and young patients without advanced cardiopathy presented good functional behavior. Elderly patients with advanced cardiopathy had more ventricular premature beats (VPB) in 24 h and less functional capacity in the exercise test than young patients of the same subgroup. There was a higher occurrence of effort-induced VPB and a lower prevalence of severe forms in elderly men, suggesting that Chagas' disease may have a worse evolution in males. The association of cardiac damage characteristic of aging with the secondary damage due to Chagas' disease could explain the greater functional damage found in elderly chagasic patients. Thus, it appears that the physiopathological components of Chagas' disease do have an influence on the clinical course of cardiopathy in the elderly population.

OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23) and left ventricular diastolic diameter (r=0.30). The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.

Em estudo duplo-cego observou-se que as alterações radiológicaspulmonares após tratamento com oxamniquine de pacientes com esquistossomose mansoni crônica associam-se com a presença de eosinófilos no escarro (p

In a double-blind study, thepost-oxamniquine X-ray pulmonary alterations were associated with sputum eosinophilia (p < 0.01). This suggests the occurrence of a hypersensitivity reaction in treated human schistosomiasis mansoni infections.