Revista clinica espanola · 2026
Pharmacological and interventional strategies for chronic Chagas cardiomyopathy: a systematic review of clinical outcomes.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Ramírez-Olivencia G, Muñoz Nieto C, Fernández Tomás M, Martí Sánchez D
Аннотация
BACKGROUND: Chronic Chagas Cardiomyopathy (CCC), the main chronic manifestation ofTrypanosoma cruzi infection, is a major global health burden causing heart failure, arrhythmias, and sudden death. Despite recommendations for conventional heart failure therapies, specific evidence for non-antiparasitic interventions in CCC is limited, creating significant clinical uncertainty.
OBJECTIVES: This systematic review aimed to synthesize the available evidence from Randomized Controlled Trials (RCTs) regarding the efficacy and safety of non-antiparasitic pharmacological and device-based therapies in CCC, specifically focusing on hard clinical outcomes such as mortality and hospitalizations.
METHODS: We conducted a systematic search following PRISMA guidelines in PubMed, Web of Science, LILACS, MEDLINE, and BVS on May 1, 2025 (coverage through April 30, 2025; see Appendix 1). Blinded RCTs in adults with CCC evaluating non-antiparasitic therapies were included. The methodological quality was assessed using the Cochrane Risk of Bias (RoB) tool, and a narrative synthesis was performed due to clinical heterogeneity.
RESULTS: Six blinded RCTs were included. The primary finding is a notable gap: none of the six included RCTs reported data on all-cause mortality or cardiovascular hospitalizations. Conventional agents (e.g., carvedilol, ACE inhibitors) did not demonstrate consistent benefit in improving myocardial function. Antiarrhythmic drugs showed partial efficacy but were associated with unfavorable risk-benefit profiles or a high/uncertain risk of bias.
CONCLUSIONS: There is a limited evidence of robust, reliable evidence from blinded RCTs to guide non-antiparasitic therapeutic strategies in CCC. This notable gap precludes establishing evidence-based recommendations for prognostic management. Consequently, management must continue to rely on extrapolated data from general heart failure guidelines. Urgent funding and execution of adequately powered RCTs that address hard clinical endpoints are necessary.
OBJECTIVES: This systematic review aimed to synthesize the available evidence from Randomized Controlled Trials (RCTs) regarding the efficacy and safety of non-antiparasitic pharmacological and device-based therapies in CCC, specifically focusing on hard clinical outcomes such as mortality and hospitalizations.
METHODS: We conducted a systematic search following PRISMA guidelines in PubMed, Web of Science, LILACS, MEDLINE, and BVS on May 1, 2025 (coverage through April 30, 2025; see Appendix 1). Blinded RCTs in adults with CCC evaluating non-antiparasitic therapies were included. The methodological quality was assessed using the Cochrane Risk of Bias (RoB) tool, and a narrative synthesis was performed due to clinical heterogeneity.
RESULTS: Six blinded RCTs were included. The primary finding is a notable gap: none of the six included RCTs reported data on all-cause mortality or cardiovascular hospitalizations. Conventional agents (e.g., carvedilol, ACE inhibitors) did not demonstrate consistent benefit in improving myocardial function. Antiarrhythmic drugs showed partial efficacy but were associated with unfavorable risk-benefit profiles or a high/uncertain risk of bias.
CONCLUSIONS: There is a limited evidence of robust, reliable evidence from blinded RCTs to guide non-antiparasitic therapeutic strategies in CCC. This notable gap precludes establishing evidence-based recommendations for prognostic management. Consequently, management must continue to rely on extrapolated data from general heart failure guidelines. Urgent funding and execution of adequately powered RCTs that address hard clinical endpoints are necessary.