Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
PLoS Negl Trop Dis. 2018 Jun 13;12(6):e0006567. doi: 10.1371/journal.pntd.0006567. eCollection 2018 Jun.
Chagas disease (CD) is a major public health concern in Latin America and a potentially serious emerging threat in non-endemic countries. Although the association between CD and cardiac abnormalities is widely reported, study design diversity, sample size and quality challenge the information, calling for its update and synthesis, which would be very useful and relevant for physicians in non-endemic countries where health care implications of CD are real and neglected. We performed to systematically review and meta-analyze population-based studies that compared prevalence of overall and specific ECG abnormalities between CD and non-CD participants in the general population.
Six databases (EMBASE, Ovid Medline, Web of Science, Cochrane Central, Google Scholar and Lilacs) were searched systematically. Observational studies were included. Odds ratios (OR) were computed using random-effects model.
Forty-nine studies were selected, including 34,023(12,276 CD and 21,747 non-CD). Prevalence of overall ECG abnormalities was higher in participants with CD (40.1%; 95%CIs=39.2-41.0) compared to non-CD (24.1%; 95%CIs=23.5-24.7) (OR=2.78; 95%CIs=2.37-3.26). Among specific ECG abnormalities, prevalence of complete right bundle branch block (RBBB) (OR=4.60; 95%CIs=2.97-7.11), left anterior fascicular block (LAFB) (OR=1.60; 95%CIs=1.21-2.13), combination of complete RBBB/LAFB (OR=3.34; 95%CIs=1.76-6.35), first-degree atrioventricular block (A-V B) (OR=1.71; 95%CIs=1.25-2.33), atrial fibrillation (AF) or flutter (OR=2.11; 95%CIs=1.40-3.19) and ventricular extrasystoles (VE) (OR=1.62; 95%CIs=1.14-2.30) was higher in CD compared to non-CD participants.
This systematic review and meta-analysis provides an update and synthesis in this field. This research of observational studies indicates a significant excess in prevalence of ECG abnormalities (40.1%) related to T. cruzi infection in the general population from Chagas endemic regions, being the most common ventricular (RBBB and LAFB), and A-V B (first-degree) node conduction abnormalities as well as arrhythmias (AF or flutter and VE). Also, prevalence of ECG alterations in children was similar to that in adults and suggests earlier onset of cardiac disease.
恰加斯病（CD）是拉丁美洲的一个主要公共卫生问题，也是非流行国家潜在的严重新出现威胁。尽管 CD 与心脏异常之间存在关联已被广泛报道，但研究设计的多样性、样本量和质量挑战了这一信息，因此需要更新和综合，这对于非流行国家的医生来说非常有用和相关，因为 CD 的医疗保健意义是真实存在且被忽视的。我们进行了系统评价和荟萃分析，比较了一般人群中 CD 患者和非 CD 患者的总体和特定心电图异常的患病率。
系统地检索了六个数据库（EMBASE、Ovid Medline、Web of Science、Cochrane Central、Google Scholar 和 Lilacs）。纳入观察性研究。使用随机效应模型计算比值比（OR）。
共选择了 49 项研究，包括 34023 名（12276 名 CD 和 21747 名非 CD）参与者。与非 CD 参与者相比，CD 参与者的总体心电图异常患病率更高（40.1%；95%CI=39.2-41.0）（OR=2.78；95%CI=2.37-3.26）。在特定的心电图异常中，完全性右束支传导阻滞（RBBB）（OR=4.60；95%CI=2.97-7.11）、左前分支阻滞（LAFB）（OR=1.60；95%CI=1.21-2.13）、完全性 RBBB/LAFB 组合（OR=3.34；95%CI=1.76-6.35）、一度房室传导阻滞（A-V B）（OR=1.71；95%CI=1.25-2.33）、心房颤动（AF）或扑动（OR=2.11；95%CI=1.40-3.19）和室性期前收缩（VE）（OR=1.62；95%CI=1.14-2.30）的患病率在 CD 参与者中更高。
本系统评价和荟萃分析提供了该领域的最新信息和综合结果。这些观察性研究表明，在恰加斯病流行地区的一般人群中，与 T. cruzi 感染相关的心电图异常（40.1%）患病率显著增加，最常见的是心室（RBBB 和 LAFB）和 A-V B（一度）结传导异常以及心律失常（AF 或扑动和 VE）。此外，儿童心电图改变的患病率与成人相似，表明心脏病的发病更早。
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