Human Activity Profile Questionnaire: functional assessment and screening for systolic dysfunction in patients with Chagas cardiomyopathy

Background:  Patients with chronic Chagas cardiomyopathy (CCC) may present with fatigue and dyspnea, which contribute to functional impairment. However, simple and inexpensive methods for evaluation of functional impairment and identification of left ventricular (LV) systolic dysfunction in patients with CCC are lacking. The Human Activity Profile (HAP) has potential in functional evaluation of patients with CCC. This study was conducted to analyze the association between HAP, functional parameters, and LV systolic dysfunction in patients with CCC, and to demonstrate the accuracy of HAP in identifying LV systolic dysfunction in patients with CCC.

Methods:  One hundred and twenty-six patients with CCC (NYHA I-III, 18.9% with LV systolic dysfunction) were evaluated using echocardiography, the 60-second sit-to-stand test (STS60, for lower limb strength and endurance), and the HAP questionnaire. In addition, the gait speed and handgrip strength of each patient was measured.

Results:  HAP score was correlated with gait speed (r=-0.206; p=0.023), STS60 score (r=0.199, p=0.030), and handgrip strength (r=0.315, p<0.01). Binary logistic regression showed that HAP score was the only functional variable associated with LV systolic dysfunction. Patients with LV systolic dysfunction (n=24) had lower HAP scores than those without LV systolic dysfunction (n=102) (p <0.01). The area under the ROC curve indicated that HAP score had an acceptable discriminatory ability to identify LV systolic dysfunction in patients with CCC (AUC=0.713). The optimal cut-off HAP score for identifying these patients was <56 points.

Conclusion:  HAP score is associated with LV systolic dysfunction in patients with CCC.

Keywords:
Chagas disease; Chagas cardiomyopathy; Exercise; Activities of daily living; Human activities