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Impact of cardiac structure and function on exercise intolerance in Chagas cardiomyopathy: Insights from CPET and
Jhessica Macieira Pereira1, Enrico de Francisco Magnani1, Denise Mayumi Tanaka2
1Federal University of Minas Gerais, Belo Horizonte, Brazil.
Insights
Functional capacity in Chronic Chagas cardiomyopathy (CCC) is influenced by disease severity, male sex, and left ventricular systolic and diastolic function. These factors are key determinants of peak oxygen consumption (VO2peak) in CCC patients.
Area of Science:
- Cardiology
- Exercise Physiology
- Chagas Disease Research
Background:
- Chronic Chagas cardiomyopathy (CCC) significantly impairs functional capacity, causing symptoms like fatigue and dyspnea.
- The specific factors determining reduced functional capacity in CCC remain incompletely understood.
- Evaluating peak oxygen consumption (VO2peak) is crucial for assessing functional capacity in CCC patients.
Purpose of the Study:
- To evaluate the peak oxygen consumption (VO2peak) in patients diagnosed with Chronic Chagas cardiomyopathy (CCC).
- To identify the clinical and echocardiographic factors independently associated with VO2peak in CCC patients.
Main Methods:
- An observational study included 97 patients with CCC.
- Standard clinical evaluation, cardiopulmonary exercise testing (CPET), and echocardiography were performed.
- Multivariate linear regression analysis identified predictors of VO2peak and percentage of predicted VO2.
Main Results:
- Patients with CCC had a median VO2peak of 16.1 ml/Kg/min.
- VO2peak was significantly associated with age, male sex, NYHA functional class, left ventricle ejection fraction (LVEF), left atrium diameter, LV diastolic diameter, E wave, LV mass index, and pulmonary artery systolic pressure (PASP).
- Independent predictors of VO2peak were age, male sex, LVEF, and E wave (R²=0.69). LVEF and E wave predicted percentage of predicted VO2 (R²=0.53).
Conclusions:
- Disease severity, male sex, and left ventricular systolic and diastolic function are significant determinants of functional capacity in CCC.
- Understanding these factors can aid in managing and predicting outcomes for patients with Chronic Chagas cardiomyopathy.
Introduction:
Chronic Chagas cardiomyopathy (CCC), the most severe clinical condition of Chagas disease, often leads to a reduction in functional capacity and the appearance of symptoms such as fatigue and dyspnea on exertion. However, its determinant factors remain unclear. We aimed to evaluate the peak oxygen consumption (VO2peak) in patients with CCC and identify its determining factors.
Methods:
An observational study with 97 CCC patients was conducted. Patients underwent clinical examination, cardiopulmonary exercise test (CPET), and echocardiography as part of the standard clinical evaluation. Multivariate linear regression was used to identify independent clinical and echocardiographic predictors of VO2peak and percentage of predicted VO2.
Results:
Mean age of study patients was 55.9 ± 13.4 years, median left ventricle ejection fraction (LVEF) was 40 (26-61.5) % and median VO2peak was 16.1 (12.1-20.8) ml/Kg/min. 36 patients presented preserved LVEF and 61 presented reduced LVEF. There were significant differences in almost all CPET variables (p < 0.05) between these two groups. VO2peak was associated with age, male sex, NYHA functional class, LVEF, left atrium diameter, LV diastolic diameter, E wave, LV mass index, and pulmonary artery systolic pressure (PASP). Age, male sex, LVEF, and E wave remained independently associated with VO2peak in the multivariate analysis (R2 = 0.69), furthermore, only LVEF and E wave were associated with the predicted VO2 percentage (R2 = 0.53).
Conclusion:
In patients with CCC, disease severity, male sex, LV systolic and diastolic function influence the functional capacity.
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