Cardiac resynchronization therapy in chronic Chagas cardiomyopathy: A systematic review and single-arm meta-analysis

Background: Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure. However, patients with chronic Chagas cardiomyopathy (CCC) were underrepresented in pivotal CRT trials. Objective: This systematic review and meta-analysis aim to quantitatively describe the outcomes of CRT in patients with CCC. Methods: We systematically searched PubMed, Embase, Cochrane, and LILACS registries for studies evaluating the response to CRT in patients with CCC. We applied no language or date restrictions. We applied an inverse-variance random-effects model for a meta-analysis of proportions. Results: We included 4 observational cohort studies comprising 250 patients with CCC undergoing CRT. At CRT implantation, the mean age was 59 ± 12 years, 87% of patients (217) were New York Heart Association class III/IV, and the average left ventricular ejection fraction (LVEF) was 27% ± 7%. During a mean follow-up of 30 ± 25 months, the all-cause death rate was 38% (95% confidence interval [CI], 21-56), cardiac death rate was 29% (95% CI, 13-47), and the noncardiac death rate was 4% (95% CI, 1-9). After CRT, the proportion of patients rated New York Heart Association class III/IV was improved to 21% (95% CI, 5-44), with a pooled post-CRT LVEF of 36.3% (95% CI, 27.0-48.0). Conclusion: In patients with CCC, CRT was associated with improvements in LVEF and symptomatic and functional burden (class III/IV), but overall mortality remained high. Although CRT seems to be beneficial in this population, further research is warranted to better characterize its impact on long-term clinical outcomes.