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Respiratory sinus arrhythmia in Chagas disease. Auton Neurosci 2014; 185:149-51. [DOI: 10.1016/j.autneu.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 07/20/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
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de Alencar MCN, Rocha MODC, Lima MMDO, Costa HS, Sousa GR, Carneiro RDCB, Silva GCR, Brandão FV, Kreuser LJ, Ribeiro ALP, Nunes MCP. Heart rate recovery in asymptomatic patients with Chagas disease. PLoS One 2014; 9:e100753. [PMID: 24979699 PMCID: PMC4076274 DOI: 10.1371/journal.pone.0100753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/28/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chagas disease patients with right bundle-branch block (RBBB) have diverse clinical presentation and prognosis, depending on left ventricular (LV) function. Autonomic disorder can be an early marker of heart involvement. The heart rate recovery (HRR) after exercise may identify autonomic dysfunction, with impact on therapeutic strategies. This study was designed to assess the HRR after symptom-limited exercise testing in asymptomatic Chagas disease patients with RBBB without ventricular dysfunction compared to patients with indeterminate form of Chagas disease and healthy controls. METHODS One hundred and forty-nine subjects divided into 3 groups were included. A control group was comprised of healthy individuals; group 1 included patients in the indeterminate form of Chagas disease; and group 2 included patients with complete RBBB with or without left anterior hemiblock, and normal ventricular systolic function. A symptom-limited exercise test was performed and heart rate (HR) response to exercise was assessed. HRR was defined as the difference between HR at peak exercise and 1 min following test termination. RESULTS There were no differences in heart-rate profile during exercise between healthy individuals and patients in indeterminate form, whereas patients with RBBB had more prevalence of chronotropic incompetence, lower exercise capacity and lower HRR compared with patients in indeterminate form and controls. A delayed decrease in the HR after exercise was found in 17 patients (15%), 9% in indeterminate form and 24% with RBBB, associated with older age, worse functional capacity, impaired chronotropic response, and ventricular arrhythmias during both exercise and recovery. By multivariable analysis, the independent predictors of a delayed decrease in the HRR were age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.03 to 1.21; p = 0.010) and presence of RBBB (OR 3.97; 95% CI 1.05 to 15.01; p = 0.042). CONCLUSIONS A small proportion (15%) of asymptomatic Chagas patients had attenuated HRR after exercise, being more prevalent in patients with RBBB compared with patients in indeterminate form and controls.
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Affiliation(s)
- Maria Clara Noman de Alencar
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Manoel Otávio da Costa Rocha
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Márcia Maria de Oliveira Lima
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Henrique Silveira Costa
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Giovane Rodrigo Sousa
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renata de Carvalho Bicalho Carneiro
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Lucas Jordan Kreuser
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Antonio Luiz Pinho Ribeiro
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Carmo Pereira Nunes
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- * E-mail:
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Nunes MCP, Dones W, Morillo CA, Encina JJ, Ribeiro AL. Chagas disease: an overview of clinical and epidemiological aspects. J Am Coll Cardiol 2013; 62:767-76. [PMID: 23770163 DOI: 10.1016/j.jacc.2013.05.046] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 05/06/2013] [Accepted: 05/21/2013] [Indexed: 11/29/2022]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is a serious health problem in Latin America and is an emerging disease in non-endemic countries. In recent decades, the epidemiological profile of the disease has changed due to new patterns of immigration and successful control in its transmission, leading to the urbanization and globalization of the disease. Dilated cardiomyopathy is the most important and severe manifestation of human chronic Chagas disease and is characterized by heart failure, ventricular arrhythmias, heart blocks, thromboembolic phenomena, and sudden death. This article will present an overview of the clinical and epidemiological aspects of Chagas disease. It will focus on several clinical aspects of the disease, such as chronic Chagas disease without detectable cardiac pathology, as well as dysautonomia, some specific features, and the principles of treatment of chronic cardiomyopathy.
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Affiliation(s)
- Maria Carmo Pereira Nunes
- Hospital das Clínicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Ribeiro AL, Sabino EC, Marcolino MS, Salemi VMC, Ianni BM, Fernandes F, Nastari L, Antunes A, Menezes M, Oliveira CDL, Sachdev V, Carrick DM, Busch MP, Murphy EL. Electrocardiographic abnormalities in Trypanosoma cruzi seropositive and seronegative former blood donors. PLoS Negl Trop Dis 2013; 7:e2078. [PMID: 23469305 PMCID: PMC3585012 DOI: 10.1371/journal.pntd.0002078] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease. OBJECTIVES To assess the frequency of ECG abnormalities in T.cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction. METHODS The study retrospectively enrolled 499 seropositive blood donors in São Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%. RESULTS Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159,p<0.0003, and -0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction. CONCLUSIONS ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.
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Affiliation(s)
- Antonio L. Ribeiro
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester C. Sabino
- Department of Infectious Disease and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Milena S. Marcolino
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vera M. C. Salemi
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Barbara M. Ianni
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio Fernandes
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciano Nastari
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Antunes
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | - Márcia Menezes
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | | | - Vandana Sachdev
- National Heart, Lung and Blood Institute, Bethesda, Maryland, United States of America
| | | | - Michael P. Busch
- Blood Systems Research Institute (BSRI) and University of California at San Francisco, San Francisco, California, United States of America
| | - Eduard L. Murphy
- Blood Systems Research Institute (BSRI) and University of California at San Francisco, San Francisco, California, United States of America
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Barbosa MM, Nunes MCP. Estratificación del riesgo en la enfermedad de Chagas. Rev Esp Cardiol 2012; 65 Suppl 2:17-21. [DOI: 10.1016/j.recesp.2012.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anthropometric measures and vagal indexes of heart rate variability in a population with a high prevalence of Chagas disease—differences according to obesity status. Int J Cardiol 2012; 156:113-5. [DOI: 10.1016/j.ijcard.2012.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/10/2012] [Indexed: 11/23/2022]
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Chuenkova MV, Pereiraperrin M. Neurodegeneration and neuroregeneration in Chagas disease. ADVANCES IN PARASITOLOGY 2011; 76:195-233. [PMID: 21884893 DOI: 10.1016/b978-0-12-385895-5.00009-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autonomic dysfunction plays a significant role in the development of chronic Chagas disease (CD). Destruction of cardiac parasympathetic ganglia can underlie arrhythmia and heart failure, while lesions of enteric neurons in the intestinal plexuses are a direct cause of aperistalsis and megasyndromes. Neuropathology is generated by acute infection when the parasite, though not directly damaging to neuronal cells, elicits immune reactions that can become cytotoxic, inducing oxidative stress and neurodegeneration. Anti-neuronal autoimmunity may further contribute to neuropathology. Much less clear is the mechanism of subsequent neuronal regeneration in patients that survive acute infection. Morphological and functional recovery of the peripheral neurons in these patients correlates with the absence of CD clinical symptoms, while persistent neuronal deficiency is observed for the symptomatic group. The discovery that Trypanosoma cruzi trans-sialidase can moonlight as a parasite-derived neurotrophic factor (PDNF) suggests that the parasite might influence the balance between neuronal degeneration and regeneration. PDNF functionally mimics mammalian neurotrophic factors in that it binds and activates neurotrophin Trk tyrosine kinase receptors, a mechanism which prevents neurodegeneration. PDNF binding to Trk receptors triggers PI3K/Akt/GSK-3β and MAPK/Erk/CREB signalling cascades which in neurons translates into resistance to oxidative and nutritional stress, and inhibition of apoptosis, whereas in the cytoplasm of infected cells, PDNF represents a substrate-activator of the host Akt kinase, enhancing host-cell survival until completion of the intracellular cycle of the parasite. Such dual activity of PDNF provides sustained activation of survival mechanisms which, while prolonging parasite persistence in host tissues, can underlie distinct outcomes of CD.
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Affiliation(s)
- Marina V Chuenkova
- Department of Pathology and Sackler School of Graduate Students, Tufts University School of Medicine, Boston, Massachusetts, USA
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VERRIER RICHARDL, NIEMINEN TUOMO. T-Wave Variability, the New Microvolt “Buzz” in Arrhythmia Risk Assessment: Any Links to TWA? J Cardiovasc Electrophysiol 2011; 22:806-7. [DOI: 10.1111/j.1540-8167.2011.02026.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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RIBEIRO ANTONIOLUIZPINHO, ROCHA MANOELOTÁVIODACOSTA, TERRANOVA PAOLO, CESARANO MARCO, NUNES MARIADOCARMOPEREIRA, LOMBARDI FEDERICO. T-Wave Amplitude Variability and the Risk of Death in Chagas Disease. J Cardiovasc Electrophysiol 2011; 22:799-805. [DOI: 10.1111/j.1540-8167.2010.02000.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pereira Nunes MDC, Barbosa MM, Ribeiro ALP, Amorim Fenelon LM, Rocha MOC. Predictors of mortality in patients with dilated cardiomyopathy: relevance of chagas disease as an etiological factor. Rev Esp Cardiol 2010; 63:788-97. [PMID: 20609312 DOI: 10.1016/s1885-5857(10)70163-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Previous studies on the influence of Chagas disease on mortality in patients with heart failure were limited by the heterogeneity of the patient populations. Few data are available on the association between the underlying cause of dilated cardiomyopathy and long-term prognosis. The aims of this study were to identify risk factors for mortality in patients with dilated cardiomyopathy that was either secondary to Chagas disease or idiopathic and to determine the prognostic value of identifying Chagas disease as the underlying etiology of dilated cardiomyopathy. METHODS We investigated outcomes in 287 patients with heart failure secondary to dilated cardiomyopathy. Patients were divided into two groups according to the underlying etiology: Chagas cardiomyopathy (224 patients) and idiopathic dilated cardiomyopathy (63 patients). The study end-points were death and heart transplantation. RESULTS Over a median follow-up period of 39.5 months, 104 patients died and 9 underwent heart transplantation. Under multivariate Cox proportional hazards analysis, New York Heart Association functional class, left ventricular ejection fraction, right ventricular function and left atrial volume remained predictors of an adverse outcome. Chagas etiology was also independently associated with a poor prognosis (hazard ratio=2.48; 95% confidence interval, 1.28-4.78; P=.007) compared with idiopathic disease, after adjustment for other well-established predictive parameters in heart failure. CONCLUSIONS The identification of Chagas etiology in patients with dilated cardiomyopathy was of prognostic significance. Chagas cardiomyopathy was associated with poorer survival compared with idiopathic disease, irrespective of other clinical and echocardiographic parameters related to a poor prognosis in heart failure.
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Factores predictivos de la mortalidad en pacientes con miocardiopatía dilatada: importancia de la enfermedad de Chagas como etiología. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70181-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A hundred years from its description, Chagas cardiomyopathy remains a challenging disease. Although successful vector-control strategies have decreased the incidence of Chagas disease in several Latin American countries, both migration to urban areas and immigration have spread the disease worldwide; and now, blood transfusion, organ transplantation, and vertical transmission are a concern. The pathogenesis of Chagas cardiomyopathy involves complex host-parasite interactions, where low-grade but incessant systemic infection and triggered autoimmune reaction are the main mechanisms for its development, with the contribution of autonomic damage and microvascular disturbances. Chagas cardiomyopathy is the most important clinical presentation of Chagas disease and comprises a wide range of manifestations, including heart failure, arrhythmias, heart blocks, sudden death, thromboembolism, and stroke. Recently, simple clinical prognostic scores have been developed to identify high-risk patients and help with management. The treatment of Chagas cardiomyopathy focuses mostly on managing heart failure, arrhythmias, and thromboembolism. The role of specific antiparasitic therapy in the chronic form is not yet defined, and a randomized trial is now under way to address this crucial point. In this article, we review the main clinical aspects of Chagas cardiomyopathy and underscore some upcoming challenges for the appropriate control, diagnosis, and management of this complex disease.
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Affiliation(s)
- Andréia Biolo
- Division of Cardiology, Hospital de Clínicas de Porto Alegre and Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Ribeiro ALP, Campos MS, Baptista LMG, de Sousa MR. The Valsalva maneuver in Chagas disease patients without cardiopathy. Clin Auton Res 2009; 20:79-83. [PMID: 19941031 DOI: 10.1007/s10286-009-0044-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 11/05/2009] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To perform a meta-analysis of studies using the Valsalva ratio (VR) in Chagas disease (ChD) patients without cardiopathy in comparison to control subjects in order to determine if vagal heart modulation is impaired in early forms of ChD. METHODS The medical literature was systematically searched and reviewed for cross-sectional studies in humans in which the Valsalva maneuver was used to evaluate the autonomic modulation of the heart in ChD patients without cardiopathy. The Hedges g statistic (software Medcalc v.9.4.0.0) was used to combine the results of all studies through the calculation of the summary standardized mean difference (SMD): the mean VR in controls minus the mean VR in ChD patients, divided by the pooled and adjusted standard deviation. The sample size necessary to detect this SMD with 80% of power was calculated using the G*Power software v.3.0. RESULTS The meta-analysis included 396 patients in 7 studies. Summary mean VRs were 1.87 +/- 0.39 ms in controls versus 1.74 +/- 0.40 ms in ChD without cardiopathy, leading to a statistically significant summary SMD of -0.310 (95% CI -0.513 to -0.106). Considering the summary SMD of -0.31, an alpha error of 0.05 and a 1:1 ratio of ChD and control patients, the estimated total sample size for a study with 80% power was 330 patients. INTERPRETATION ChD patients without cardiopathy have reduced VR values compared to healthy controls, indicating early vagal dysfunction. Most previous studies could not detect this impairment due to small study samples and insufficient statistical power.
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Affiliation(s)
- Antonio L P Ribeiro
- Serviço de Cardiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190-Campus Saúde, Belo Horizonte, 30130-100, Brazil.
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Ribeiro ALP, Cassini P, Peixoto SV, Lima-Costa MF. Vagal impairment in elderly Chagas disease patients: a population-based study (the Bambuí study). Int J Cardiol 2009; 147:359-65. [PMID: 19875184 DOI: 10.1016/j.ijcard.2009.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 07/11/2009] [Accepted: 10/11/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chagas disease (ChD) will become predominantly a disease of the elderly, as a consequence of the effectiveness of control measures in many Latin American countries. The effects of the disease in old age have received little attention. We investigated the effects of ageing in the association between cardiac vagal impairment, a typical feature of ChD, and chronic Trypanosoma cruzi infection. METHODS The study sample of this cross-sectional study consists of 1014 subjects ≥ 60 years old (mean age = 68.3; SD = 6.9) residing in Bambuí City (Southeast Brazil). ECG was recorded and one-breath sinus arrhythmia test was performed. Maximal expiratory over the minimal inspiratory (E:I) ratio and heart rate variability (HRV) measurements were calculated. Ordinal logistic regression was used to assess the relation between vagal indexes and chronic T. cruzi infection. RESULTS The prevalence of T. cruzi infection was 32.0% and of major ECG abnormalities, 43.4%. Among individuals aged 60-69 years, T. cruzi infection was significantly and independently associated with reduced SDNN (OR 0.38; 95% CI 0.27-0.53), RMSSD (OR 0.48; 0.34-0.67) and EI: ratio (OR 0.45; 95% CI 0.33-0.63). Among individuals aged >70 years, no significant odds ratios were found in either the unadjusted or the adjusted analysis. The presence of major ECG abnormalities did not affect the association between vagal indexes and T. cruzi infection. CONCLUSIONS Disease-specific vagal cardiac dysfunction was observed in ChD individuals below 70. However, further ageing interferes significantly with vagal heart modulation, attenuating the difference of HRV indexes between ChD and non-ChD subjects.
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Affiliation(s)
- Antonio Luiz P Ribeiro
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Ribeiro ALP, Campos de Carvalho AC, Lombardi F, Teixeira MM, Costa Rocha MO. Enhanced parasympathetic activity in Chagas disease still stands in need of proof. Int J Cardiol 2009; 135:406-8. [PMID: 18599135 PMCID: PMC3210577 DOI: 10.1016/j.ijcard.2008.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Accepted: 03/01/2008] [Indexed: 02/08/2023]
Abstract
Cardiac vagal modulation impairment is a typical feature of Chagas disease (ChD) and is correlated to antagonistic anti-M2 autoantibodies activity. In this letter, we analyze the hypothesis that, in ChD, anti-muscarinic antibody activity could simultaneously increase parasympathetic tonus (decreasing heart rate) and decrease vagal modulation over cardiac sinus node (reducing heart rate variability - HRV). Although attractive, this hypothesis is not supported by empirical data, since reduction of vagal-specific HRV indexes has been demonstrated in the absence of bradycardia. Moreover, anti-muscarinic antibody levels correlate with HRV indexes, but not with heart rate. In the absence of reduced heart rate and, consequently, of tonic vagal enhancement, it is impossible to explain the reduction of vagal-mediated HRV by continuous and strong muscarinic activity of autoantibodies in ChD.
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Affiliation(s)
- Antonio Luiz P. Ribeiro
- Hospital das Clínicas and Post-Graduation in Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Av. Alfredo Balena, 190-Campus Saúde, 30130-100, Belo Horizonte, Brazil
- Corresponding author. Rua Campanha, 98/101, 30310-770, Belo Horizonte, MG, Brazil. Tel.: +55 31 32879213; fax: +55 31 32847298. (A.L.P. Ribeiro)
| | - Antonio Carlos Campos de Carvalho
- Laboratório de Cardiologia Celular e Molecular, Instituto de Biofísica Carlos Chagas Filho CCS, Federal University of Rio de Janeiro, Bloco G, Sala G2-045. Cidade Universitaria - Ilha do Fundão Rio de Janeiro, RJ, 21949-900, Brazil
| | - Federico Lombardi
- Cardiologia, Ospedale San Paolo, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano, Via A. De Rudini, 8, 20142, Milano, Italy
| | - Mauro Martins Teixeira
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, 31270-910. Belo Horizonte, Brazil
| | - Manoel Otávio Costa Rocha
- Hospital das Clínicas and Post-Graduation in Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Av. Alfredo Balena, 190-Campus Saúde, 30130-100, Belo Horizonte, Brazil
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Sousa L, Rocha MODC, Britto RR, Lombardi F, Ribeiro AL. Chagas disease alters the relationship between heart rate variability and daily physical activity. Int J Cardiol 2008; 135:257-9. [PMID: 18585804 DOI: 10.1016/j.ijcard.2008.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 03/01/2008] [Indexed: 11/25/2022]
Abstract
Regular exercise training is considered to be capable of beneficially modifying the autonomic balance in healthy subjects. We studied the association between vagal HRV indexes and the level of physical activity in Chagas disease patients and control subjects. Although in controls habitual physical activity was closely associated with vagal HRV indexes, no relationship was found between IPAQ scores and HRV indexes in a Chagas disease group, suggesting that Chagas dysautonomia disrupted this potentially beneficial association.
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Rocha MOC, Teixeira MM, Ribeiro AL. An update on the management of Chagas cardiomyopathy. Expert Rev Anti Infect Ther 2007; 5:727-43. [PMID: 17678433 DOI: 10.1586/14787210.5.4.727] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, infects nearly 18 million people in Latin America and mainly affects the heart, causing heart failure, arrhythmias, heart block, thromboembolism, stroke and death. In this review, the clinical diagnosis and management of Chagas cardiomyopathy are discussed. Particular emphasis is placed on the clinical staging of patients and the use of various diagnostic tests that may be useful in individualizing treatment of the two most relevant clinical syndromes, that is, heart failure and arrhythmias. The relevance of specific treatments are discussed, stressing the important role of parasite persistence in disease pathogenesis. We also discuss new therapy modalities that may have a role in the treatment of Chagas cardiomyopathy.
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Affiliation(s)
- Manoel O C Rocha
- Internal Medicine Department and Coordinator, Postgraduate Course of Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Ribeiro ALP, Giménez LED, Hernández CCQ, de Carvalho ACC, Teixeira MM, Guedes VC, Barros MVL, Lombardi F, Rocha MODC. Early occurrence of anti-muscarinic autoantibodies and abnormal vagal modulation in Chagas disease. Int J Cardiol 2007; 117:59-63. [PMID: 16859766 DOI: 10.1016/j.ijcard.2006.04.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 04/06/2006] [Accepted: 04/28/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autoimmunity and dysautonomia are established features of Chagas disease (ChD) that could be related to its pathogenesis. Our objective was to assess heart rate variability (HRV) and levels of anti-M2 receptors autoantibodies in ChD patients with and without left ventricular (LV) dysfunction, in order to establish if these abnormalities occur early and concomitantly in the course of the illness. METHODS ChD patients (n=75) and healthy controls (n=14) underwent a standardized protocol including Doppler echocardiogram, Holter monitoring, HRV analysis, and measurement of anti-M2 receptors autoantibodies (ELISA). ChD patients were divided accordingly by the absence (group 1, n=45) or presence (group 2, n=30) of LV dysfunction, defined as reduced LV ejection fraction (<55%) or regional wall motion abnormalities (including ventricular aneurysm). RESULTS Both ChD groups displayed increased optical density values of anti-M2 cholinergic autoantibodies (Median (IQR): control=1.98(0.51); ChD 1=2.76(0.97); ChD 2=2.72(1.34), p<.001) and reduced HF power of spectral analysis of HRV when compared to controls (Median (IQR) in ms2: control=1087(2284); ChD 1=286(763); ChD 2=285(763), p<.001). M2 levels were significantly correlated with HF power values (r=-0.32, p=0.023), but not with LV ejection fraction. CONCLUSIONS Anti-muscarinic autoantibodies and abnormal vagal modulation occur early in ChD patients, independently of the presence of LV dysfunction. Levels of antibodies against M2 muscarinic receptors were significantly and negatively correlated with HRV index HF power, suggesting an inhibitory effect of autoantibodies in vagal function.
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Affiliation(s)
- Antonio Luiz Pinho Ribeiro
- Postgraduate Course of Tropical Medicine, School of Medicine, Av. Alfredo Balena, 190-Campus Saúde, 30130-100. Belo Horizonte, Brazil.
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