Risk of Chronic Cardiomyopathy Development and Its Determinants in Patients with the Acute Phase and Indeterminate Form of Chagas Disease: A Systematic Review and Meta-Analysis

Background: Chagas cardiomyopathy causes substantial morbidity and mortality. We lack precise estimates of the risk of cardiomyopathy development among patients with the acute and indeterminate forms of Chagas disease. We aim to calculate the cardiomyopathy risk in Chagas infection.Methods: We systematically searched MEDLINE, Web of Science Core Collection, Embase, Cochrane Library, and LILACS. We included studies published from 1945 to October 2018 that included a longitudinal observation of participants with the acute acquisition of the infection or diagnosis of the indeterminate form until the development of cardiomyopathy. Studies were excluded if they did not state enough outcome data. Studies critical appraisals were performed utilizing the JBI Reviewer’s Manual checklists, and data were collected from published studies. We used random-effects meta-analysis to obtain pooled estimated annual rates.Findings: 5,005 studies were screened for eligibility. 298 full-text articles were reviewed, and 178 were considered for inclusion in the synthesis. Twenty-three studies had longitudinal observation outcomes for the chronic indeterminate form of Chagas disease and nine for acute Chagas infection. We found a pooled annual rate estimate of cardiomyopathy in chronic indeterminate Chagas patients of 1∙9% per year (95% CI: 1·3 - 3·0%, I2 =98·0%, τ2 (ln scale) = 0·9992); and of 4∙6% (95% CI: 2·7 - 7·9 %, I2 =86·6%, τ2 (ln scale) = 0·4946) per year in acute chagasic patients.Interpretation: People living with the indeterminate form of chronic Chagas disease have a significant annual risk of cardiomyopathy development. This risk more than double for patients diagnosed with acute infection.Funding Statement: No funding agencies had any role in the preparation, review, or approval of this manuscript. This publication was supported by NIH/NCRR Colorado CTSI Grant Number UL1 RR025780. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: Systematic review registration number: PROSPERO CRD42019118019.