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Gonçalves AJ, Braga MVA, Santana PH, Resende LAPR, da Silva VJD, Correia D. Linear and non-linear analysis of heart rate variability in HIV-positive patients on two different antiretroviral therapy regimens. BMC Infect Dis 2021; 21:1022. [PMID: 34587909 PMCID: PMC8482565 DOI: 10.1186/s12879-021-06648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Cardiac autonomic dysfunction in HIV+ patients on different antiretroviral therapy (ART) regimens has been described. We aimed to characterize parameters of heart rate variability (HRV) and correlate with different classes of ART in HIV+ patients in three experimental conditions: rest, cold face, and tilt tests. Methods Cross-sectional study with three groups of age- and gender-matched individuals: group 1, 44 HIV+ patients undergoing combination therapy, with two nucleoside reverse transcriptase inhibitors (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI); group 2, 42 HIV+ patients using two NRTI and protease inhibitors (PI’s); and group 3, 35 healthy volunteers with negative HIV serology (control group). Autonomic function at rest and during cold face- and tilt-tests was assessed through computerized analysis of HRV, via quantification of time- and frequency domains by linear and non-linear parameters in the three groups. Results Anthropometric and clinical parameters were similar between both HIV groups, except CD4+ T lymphocytes, which were significantly lower in group 2 (p = 0.039). At baseline, time-domain linear HRV parameters, RMSSD and pNN50, and the correlation dimension, a non-linear HRV parameter (p < 0.001; p = 0.018; p = 0.019, respectively), as well as response of RMSSD to cold face test were also lower in the HIV+ group than in the control individuals (p < 0.001), while no differences among groups were detected in HRV parameters during the tilt test. Conclusions Despite ART regimens, HIV+ patients presented lower cardiac vagal modulation than controls, whereas no difference was observed among the HIV groups, suggesting that higher cardiovascular risk linked to PIs may be associated with factors other than autonomic dysfunction.
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Affiliation(s)
- Anderson José Gonçalves
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil
| | | | | | | | - Valdo José Dias da Silva
- Physiology Division, Biological Science Department, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais State, Brazil
| | - Dalmo Correia
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil.
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Fortes Silva HE, de Almeida RS, Silveira DB, Llaguno M, Resende LAPR, Dias da Silva VJ, Correia D. Cardiac autonomic modulation and long-term use of amiodarone in patients with chronic Chagasic cardiopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:788-798. [PMID: 29781516 DOI: 10.1111/pace.13384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with chronic Chagas cardiopathy (CCC), which may be associated with cardiac arrhythmias, frequently use amiodarone, an antiarrhythmic drug that, experimentally, appears to modulate the cardiac autonomic function. OBJECTIVE The present cross-sectional observational study aimed to evaluate autonomic cardiac modulation in patients with CCC undergoing chronic amiodarone therapy. METHODS Three groups were investigated: Group 1 included patients with CCC not treated with amiodarone (n = 27); Group 2 included patients with CCC with prolonged use (at least 6 months) of amiodarone (n = 16); and Group 3 included non-Chagasic control patients (n = 23). All patients underwent a complete clinical and laboratory assessment, followed by autonomic function tests, consisting of a basal continuous electrocardiogram in the resting supine position for 10 minutes, followed by a change the orthostatic posture for a further 5 minutes. Heart rate variability (HRV) parameters (median and interquartile interval) were quantified using linear methods in the time- and frequency-domains (autoregressive spectral analysis) and nonlinear methods, including symbolic analysis. RESULTS Patients with CCC using amiodarone had changes in HRV suggestive of an offset in the sympatho-vagal balance with a vagal modulation predominance (normalized HF, 49.7[27.4] vs 31.1[22.8] [P < 0.05]; and percentage 2V, 40.1 [14.6] vs 21.5 [13.4] [P < 0.05] vs untreated CCC group). These changes were further accompanied by increases in parameters indicative of greater complexity of HRV. CONCLUSIONS The deviation in the sympatho-vagal balance and the increase in the complexity of HRV strongly suggest that amiodarone may have a cardioprotective effect, in addition to its antiarrhythmic effects, which could increase the survival of these patients.
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Affiliation(s)
- Henriette Elena Fortes Silva
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Renan Sandoval de Almeida
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Danilo Batista Silveira
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Maurício Llaguno
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | | | - Valdo José Dias da Silva
- Department of Physiology, Natural and Biological Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Dalmo Correia
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
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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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Junqueira LF. Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease. Rev Soc Bras Med Trop 2012; 45:243-52. [PMID: 22535000 DOI: 10.1590/s0037-86822012000200020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/10/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Exclusive or associated lesions in various structures of the autonomic nervous system occur in the chronic forms of Chagas disease. In the indeterminate form, the lesions are absent or mild, whereas in the exclusive or combined heart and digestive disease forms, they are often more pronounced. Depending on their severity these lesions can result mainly in cardiac parasympathetic dysfunction but also in sympathetic dysfunction of variable degrees. Despite the key autonomic effect on cardiovascular functioning, the pathophysiological and clinical significance of the cardiac autonomic dysfunction in Chagas disease remains unknown. METHODS Review of data on the cardiac autonomic dysfunction in Chagas disease and their potential consequences, and considerations supporting the possible relationship between this disturbance and general or cardiovascular clinical and functional adverse outcomes. RESULTS We hypothesise that possible consequences that cardiac dysautonomia might variably occasion or predispose in Chagas disease include: transient or sustained arrhythmias, sudden cardiac death, adverse overall and cardiovascular prognosis with enhanced morbidity and mortality, an inability of the cardiovascular system to adjust to functional demands and/or respond to internal or external stimuli by adjusting heart rate and other hemodynamic variables, and immunomodulatory and cognitive disturbances. CONCLUSIONS Impaired cardiac autonomic modulation in Chagas disease might not be a mere epiphenomenon without significance. Indirect evidences point for a likely important role of this alteration as a primary predisposing or triggering cause or mediator favouring the development of subtle or evident secondary cardiovascular functional disturbances and clinical consequences, and influencing adverse outcomes.
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Affiliation(s)
- Luiz Fernando Junqueira
- Laboratório Cardiovascular, Área de Clínica Médica (Cardiologia), Universidade de Brasilia, Brasilia, DF.
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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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Llaguno M, Pertili LARDR, da Silva MV, Bunazar P, Reges AM, Faleiros ACG, Lages-Silva E, Rodrigues Junior V, da Silva VJD, Correia Filho D. The relationship between heart rate variability and serum cytokines in chronic chagasic patients with persistent parasitemia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:724-35. [PMID: 21276024 DOI: 10.1111/j.1540-8159.2010.03025.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persistent parasitemia, immunological, and autonomic nervous system impairments may play an important role in the evolution and clinical outcome of the chronic phase of Chagas' disease by triggering functional cardiovascular changes. METHODS Three groups were evaluated: 17 chronic chagasic patients with the indeterminate form (IChD), 12 chronic chagasic patients with cardiac forms (ChHD), and 29 individuals as a healthy control group. Parasitemia was assessed by polymerase chain reaction; hemoculture, heart rate variability by linear and nonlinear methods, and interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-12, IL-13, IL-17, and tumor necrosis factor-α, and interferon (IFN)-γ serum cytokines were assessed by enzyme-linked immune assay. RESULTS Twenty-nine chronic chagasic patients were positive for parasitemia (17 IChD and 12 ChHD). Heart rate variability parameters in baseline condition and after cold face test were significantly decreased in chagasic patients compared to controls. Tilt tests showed no alteration. However, using nonlinear indices, ChHD patients presented lower values compared to IChD and controls. Differences in the expression of serum cytokines were observed between chagasic patients and controls. However, among the groups, ChHD presented higher median values of IL-10 and lower of IFN-γ compared to IChD. CONCLUSION Both chagasic groups present an autonomic impairment using linear methods. The nonlinear methods revealed that the ChHD group had a higher cardiovascular risk. Serum cytokine concentrations between chagasic patients were similar. However, ChHD showed higher concentrations of IL-10 and lower of IFN-γ, suggesting some established process of immune regulation.
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Affiliation(s)
- Mauricio Llaguno
- Internal Medicine Department, Infectious Division, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Heart rate variability in chronic Chagas patients before and after treatment with benznidazole. Auton Neurosci 2010; 158:118-22. [DOI: 10.1016/j.autneu.2010.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 01/29/2010] [Accepted: 05/14/2010] [Indexed: 11/19/2022]
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Silva-Grecco RL, Balarin MAS, Correia D, Prata A, Rodrigues V. Familial analysis of seropositivity to Trypanosoma cruzi and of clinical forms of Chagas disease. Am J Trop Med Hyg 2010; 82:45-8. [PMID: 20064994 DOI: 10.4269/ajtmh.2010.08-0626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A cross-sectional study was carried out in Agua Comprida, MG, Brazil, a region previously endemic to Chagas disease whose vectorial transmission was interrupted around 20 year ago. A total of 998 individuals were examined for anti-Trypanosoma cruzi antibodies. Seropositivity was observed in 255 subjects (25.5%), and 743 subjects were negative. Forty-one families with 5-80 individuals with similar environmental conditions were selected for familial analysis. In 15 families, seropositivity to T. cruzi was observed in > 50% of individuals. The segregation analysis confirmed family aggregation for the seropositivity to the T. cruzi. Heart commitment was the major clinical form observed, and in six families, > 50% of the individuals display cardiopathy that may be attributed to T. cruzi infection. Our results support the hypothesis that there is a family aggregation for the seropositivity but without the effect of one major gene.
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Affiliation(s)
- Roseane L Silva-Grecco
- Disciplina de Genética, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais, 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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Distinctive impaired cardiac autonomic modulation of heart rate variability in chronic Chagas' indeterminate and heart diseases. J Electrocardiol 2009; 42:281-9. [DOI: 10.1016/j.jelectrocard.2008.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Indexed: 11/19/2022]
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Porto LGG, Junqueira LF. Comparison of time-domain short-term heart interval variability analysis using a wrist-worn heart rate monitor and the conventional electrocardiogram. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:43-51. [PMID: 19140912 DOI: 10.1111/j.1540-8159.2009.02175.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wrist-worn heart rate monitors have not been extensively validated for heart rate variability analysis. The purpose of this study was to compare time-domain variability of heart interval series (R-Ri) recorded by the Polar S810 monitor (Polar Electro Oy, Kempele, Finland) and the conventional electrocardiogram (ECG). METHODS Agreement was verified between variability indices of 5-minute R-Ri simultaneously recorded by both devices and processed by unique software, from 33 subjects aged 18 to 42 years, normal or with different clinical conditions, in rest supine and active standing. ECG minus Polar differences were quantified by the Bland-Altman analysis, and tested by the one-sample t-test or Wilcoxon test. RESULTS In the supine position, the Polar overestimates (P < 0.0001) the absolute and percentage mean or median of the number (-2.00; -0.49%) and mean of R-Ri (-1.85 ms; -0.20%) and pNN50 (-2.20%; -8.68%), and underestimates the standard deviation (SDNN) (0.32 ms; 0.59%) (P = 0.08; P = 0.02) and root mean square successive difference (RMSSD) (0.90 ms; 1.56%) (P = 0.0008; P < 0.0001). The coefficient of variation (CV) showed null difference. On standing, differences were overestimated for the number (-2.61 intervals; -0.64%) and mean of R-Ri (-0.70 ms; -0.09%), and underestimated for rMSSD (1.70 ms; 10.84%) (P < 0.0001 to < 0.02). The SDNN, CV, and pNN50 indices did not show differences (P = 0.12 to 0.73). CONCLUSIONS The Polar S810 monitor was feasible and reliable for recording short-term R-R interval series, showing excellent agreement with the ECG in providing the time-domain indexes of heart interval variability with differences functionally not relevant. The CV showed the higher agreement in both postures, and the SDNN and pNN50 in the standing posture.
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Affiliation(s)
- Luiz Guilherme Grossi Porto
- Cardiovascular Laboratory/Cardiology, Clinical Medicine Area and the Medical Sciences Postgraduate Course, Faculty of Medicine, University of Brasilia, Brasilia, DF, Brazil
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de Vilhena Toledo MA, Junqueira LF. Cardiac sympathovagal modulation evaluated by short-term heart interval variability is subtly impaired in Alzheimer's disease. Geriatr Gerontol Int 2008; 8:109-18. [PMID: 18713163 DOI: 10.1111/j.1447-0594.2008.00456.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Alzheimer's disease affects several nervous structures involved with the autonomic nervous system. Therefore, the still scarce evaluation of the cardiac autonomic function in this disease is of great functional, clinical, prognostic and therapeutic relevance. METHODS Time- and frequency-domain variability of 5-min R-R interval series in supine and standing positions was comparatively evaluated in 22 Alzheimer's disease subjects, aged 60-87 years (mean +/- standard error of the mean, 79.6 +/- 1.4) with variable cognitive impairment, and 24 healthy individuals, aged 60-91 years (68.6 +/- 1.6). The Student's t-test was used to compare the variability indices between the groups and logistic regression excluded the effects on these indices in the Alzheimer's group of confounding variables different from the control group (age, physical activity and caffeinated intake), at a significance level of P </= 0.05. RESULTS No difference was observed between the groups (P = 0.12-0.72) for each time-domain mean indices and for the frequency-domain indices of overall and absolute sympathetic modulation in both positions (P = 0.21-0.78). Absolute parasympathetic modulation showed borderline decrease in supine position (P = 0.07) and was reduced in the standing (P = 0.05). The sympathovagal balance was altered (P = 0.05) toward relative parasympathetic borderline depression (P = 0.07) and sympathetic exacerbation (P = 0.04) only in the supine posture. CONCLUSION Data indicate that Alzheimer's disease subjects with mild-to-severe cognitive dysfunction showed subtle, absolute and relative parasympathetic depression and relative sympathetic exacerbation, which may even so contribute to distinctive functional and cognitive disturbances.
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Affiliation(s)
- Maria Alice de Vilhena Toledo
- Clinical Medicine Area, Faculty of Medicine, University of Brasilia, and Geriatrics Medicine Center, Brasilia University Hospital, and Medical Sciences Postgraduate Course, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
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