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Risk Factors for Progression to Chronic Chagas Cardiomyopathy: A Systematic Review and Meta-Analysis
ABSTRACT.
Approximately one-third of people with chronic Trypanosoma cruzi infection develop Chagas cardiomyopathy, which carries a poor prognosis. Accurate prediction of which individuals will go on to develop Chagas cardiomyopathy remains elusive. We performed a systematic review of literature comparing characteristics of individuals with chronic Chagas disease with or without evidence of cardiomyopathy. Studies were not excluded on the basis of language or publication date. Our review yielded a total of 311 relevant publications. We further examined the subset of 170 studies with data regarding individual age, sex, or parasite load. A meta-analysis of 106 eligible studies indicated that male sex was associated with having Chagas cardiomyopathy (Hedge’s g: 1.56, 95% CI: 1.07–2.04), and a meta-analysis of 91 eligible studies indicated that older age was associated with having Chagas cardiomyopathy (Hedge’s g: 0.66, 95% CI: 0.41–0.91). A meta-analysis of four eligible studies did not find an association between parasite load and disease state. This study provides the first systematic review to assess whether age, sex, and parasite load are associated with Chagas cardiomyopathy. Our findings suggest that older and male patients with Chagas disease are more likely to have cardiomyopathy, although we are unable to identify causal relationships due to the high heterogeneity and predominantly retrospective study designs in the current literature. Prospective, multidecade studies are needed to better characterize the clinical course of Chagas disease and identify risk factors for progression to Chagas cardiomyopathy.
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Author Notes
Financial support: N. B. was supported by R01 AI107028-06 and R21 AI156669. M. S. was supported by National Institutes of Health Fogarty International Center grant numbers D43TW009340 and T32AI007001.
Authors’ addresses: Melissa K. Cutshaw, Department of Medicine, Duke University, Durham, NC, E-mail: melissa.cutshaw@duke.edu. Michael Sciaudone, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA, E-mail: msciaudo@tulane.edu. Natalie M. Bowman, Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, E-mail: natalie_bowman@med.unc.edu.