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Neves BCD, Bacilio ML, Berrueta L, Salmen S, Peterson DL, Donis JH, Nuñez TJ, Davila DF. Muscarinic antibodies and heart rate responses to dynamic exercise and to the Valsalva maneuver in chronic chagasic patients. Rev Inst Med Trop Sao Paulo 2013; 55:31-7. [PMID: 23328723 DOI: 10.1590/s0036-46652013000100006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
Abstract
We have studied the cardiac chronotropic responses to the Valsalva maneuver and to dynamic exercise of twenty chronic chagasic patients with normal left ventricular function and no segmental wall abnormalities by two-dimensional echocardiogram. The absolute increase in heart rate of the patients (Δ = 21.5 ± 10 bpm, M±SD) during the maneuver was significantly diminished when compared to controls (Δ = 31.30 ± 70, M±SD, p = 0.03). The minimum heart rate (58.24 ± 8.90 vs. 62.80 ± 10, p = 0.68) and the absolute decrease in heart rate at the end of the maneuver (Δ = 38.30 ± 13 vs. Δ = 31.47 ± 17, p = 0.10) were not different from controls. The initial heart rate acceleration during dynamic exercise (Δ = 12 ± 7.55 vs. Δ = 19 ± 7.27, M±SD, p = 0.01) was also diminished, but the heart rate recovery during the first ten seconds was more prominent in the sero-positive patients (Median: 14, Interquartile range: (9.75-17.50 vs. 5(0-8.75, p = 0.001). The serum levels of muscarinic cardiac auto-antibodies were significantly higher in the chagasic patients (Median: 34.58, Interquartile Range: 17-46.5, Optical Density) than in controls (Median: 0, Interquartile Range: 0-22.25, p = 0.001) and correlated significantly and directly (r = 0.68, p = 0.002) with early heart rate recovery during dynamic exercise. The results of this investigation indirectly suggest that, the cardiac muscarinic auto-antibodies may have positive agonist effects on parasympathetic heart rate control of chagasic patients.
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Affiliation(s)
- Barbara C das Neves
- Instituto de Investigaciones Cardiovasculares, Universidad de Los Andes, Mérida, Venezuela
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Dávila DF, Donis JH, Arata de Bellabarba G, Villarroel V, Sanchez F, Berrueta L, Salmen S, Das Neves B. Cardiac autonomic control mechanisms in the pathogenesis of chagas' heart disease. Interdiscip Perspect Infect Dis 2012; 2012:980739. [PMID: 23091486 PMCID: PMC3467757 DOI: 10.1155/2012/980739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/27/2012] [Indexed: 11/17/2022] Open
Abstract
Primary abnormalities of the autonomic nervous system had been postulated as the pathogenic mechanisms of myocardial damage, in patients with Chagas disease. However, recent investigations indicate that these abnormalities are secondary and amenable to treatment with beta-adrenergic blockers. Moreover, muscarinic cardiac autoantibodies appear to enhance parasympathetic activity on the sinus node. Therefore, the purpose of this paper is to analyze how knowledge on Chagas' disease evolved from being initially considered as a primary cardioneuromyopathy to the current status of a congestive cardiomyopathy of parasitic origin.
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Affiliation(s)
- Diego F. Dávila
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Jose H. Donis
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Gabriela Arata de Bellabarba
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Vanesa Villarroel
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Francisco Sanchez
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Lisbeth Berrueta
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Siham Salmen
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Barbara Das Neves
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
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Ribeiro ALP, de Carvalho ACC, Lombardi F, Talvani A, Teixeira MM, Rocha MOC. In vivo inhibitory effect of anti-muscarinic autoantibodies on the parasympathetic function in Chagas disease. Int J Cardiol 2010; 145:339-340. [PMID: 20051298 DOI: 10.1016/j.ijcard.2009.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 12/04/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Antonio Luiz P Ribeiro
- Hospital das Clínicas e Pós-Graduação em Clínica Médica, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190 - Campus Saúde, 30130-100, Belo Horizonte, Brazil.
| | - Antonio Carlos Campos de Carvalho
- Laboratório de Cardiologia Celular e Molecular, Instituto de Biofísica Carlos Chagas Filho, CCS, Universidade Federal do Rio de Janeiro, Bloco G,Sala G2-045. Cidade Universitária - Ilha do Fundão, 21949-900, Rio de Janeiro, RJ, Brazil
| | - Federico Lombardi
- Cardiologia, Ospedale San Paolo, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano, Via A. De Rudini, 8, 20142, Milano, Italy
| | - André Talvani
- Laboratório de Doença de Chagas, Departamento de Ciências Biológicas & Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Campus Universitário, Ouro Preto, MG, 35400-000, Brazil
| | - Mauro Martins Teixeira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, 31270-910. Belo Horizonte, Brazil
| | - Manoel Otávio Costa Rocha
- Hospital das Clínicas e Pós-Graduação em Clínica Médica, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190 - Campus Saúde, 30130-100, Belo Horizonte, Brazil
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Benchimol-Barbosa PR. Comments on the article by Ribeiro et al. 'Enhanced parasympathetic activity in Chagas' disease still stands in need of proof': definitions and biases. Int J Cardiol 2009; 146:88-90. [PMID: 19896743 DOI: 10.1016/j.ijcard.2009.09.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
Abstract
It has been hypothesized that impaired cardiac autonomic function in chagasic subject carriers of anti-muscarinic type 2 antibodies (Anti-M2) is a consequence of tonic stimulation (enhancement) of M2 receptors, thus damping high frequency spontaneous heart rate fluctuations. However, expected reduction in baseline average heart rate response as a consequence of M2 receptors stimulation has not been confirmed, imposing a query on current hypothesis for explaining autonomic impairment in Chagas' disease. In this context, possible explanations for the lack of heart rate reduction in the setting of chronic muscarinic stimulation in Chagas' disease have been discussed, based on current knowledge. Among possible factors implicated, stands out: i) spontaneous heart rate recovery after chronic vagal stimulation, ii) simultaneous anti-M2 and anti-beta 1 adrenergic receptors antibodies environments, iii) underlying cardiac function as assessed by both mechanical and humoral indexes, iv) age, v) immune status. Rigorous experimental settings may be necessary to mechanistically demonstrate eventually the association between agonistic anti-M2 environments and reduced autonomic modulation of the heart, in both humans and animal models, associated with short term and long term singular average resting heart rate balance secondary to parasympathetic stimulation.
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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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