Cardiovascular function in elderly patients with chronic chagasic cardiopathy

Abstract

The objective of this work was to verify the degree and type of heart damage of elderly chagasic patients seen at an outpatient referral center and to compare them with the changes found in young chagasic patients with a similar degree of heart damage. Elderly and young patients without advanced cardiopathy presented good functional behavior. Elderly patients with advanced cardiopathy had more ventricular premature beats (VPB) in 24 h and less functional capacity in the exercise test than young patients of the same subgroup. There was a higher occurrence of effort-induced VPB and a lower prevalence of severe forms in elderly men, suggesting that Chagas' disease may have a worse evolution in males. The association of cardiac damage characteristic of aging with the secondary damage due to Chagas' disease could explain the greater functional damage found in elderly chagasic patients. Thus, it appears that the physiopathological components of Chagas' disease do have an influence on the clinical course of cardiopathy in the elderly population. Key-words: Chagas' disease. Chagasic cardiomyopathy. Cardiovascular function. Elderly.Resumo Este trabalho tem como objetivo verificar o grau e tipo de comprometimento orgânico-funcional cardíaco dos pacientes chagásicos idosos e compará-los com as alterações evidenciadas por chagásicos jovens com grau semelhante de dano miocárdico. Verificou-se que idosos sem cardiopatia avançada apresentaram bom comportamento funcional, semelhante ao dos jovens do mesmo estádio clínico. Idosos com formas avançadas apresentaram mais extra-sistolia ventricular ao Holter e menor capacidade funcional à ergometria que jovens do mesmo sub-grupo. Houve maior ocorrência de ESV esforço-induzida e menor prevalência de formas graves nos homens idosos, sugerindo evidências de pior evolução da doença de Chagas no sexo masculino. A associação de alterações cardíacas próprias do envelhecimento ao dano secundário à doença de Chagas poderia explicar o maior comprometimento funcional encontrado em idosos. Assim, os componentes fisiopatológicos da doença de Chagas parecem influenciar a evolução da cardiopatia na população idosa. Palavras-chaves: Doença de Chagas. Cardiomiopatia chagásica. Função cardiovascular. Idosos.

Vagal impairment in elderly Chagas disease patients: A population-based study (The Bambuí Study)

“…Because there is no undisputable effective treatment for chronic infection, despite the effectiveness of the control measures, the disease might remain a public health problem for some decades among older subjects, through the operation of a cohort effect [4]. The effect of T. cruzi infection on the elderly has hardly been studied [4][5][6][7][8][9] and deserves more attention from the scientific community and from policy makers. Impairment of cardiac vagal modulation has been consistently reported in ChD [10][11][12][13] and may be related to both autoimmune and inflammatory mechanisms [14,15].…”

Chagas disease and mortality in old age as an emerging issue: 10 year follow-up of the Bambuí population-based cohort study (Brazil)

“…Nonetheless, more recent studies have shown that the clinical manifestations of ChD in old ages are similar -or even worse -than those observed in young adults [9][10][11][12]. Indeed, an analysis of mortality and public hospitalization rates in Brazil in the last decades showed that a substantial toll of the burden of T. cruzi infection affected older adults [4], suggesting that ChD in the elderly might be more severe and potentially lethal than suspected in earlier studies.…”

Chagas disease: Impaired vagal modulation has been demonstrated, enhanced parasympathetic activity remains to be proved

“…The present burden of T. cruzi infection for the elderly living in areas where the transmission has been interrupted has been scarcely studied and deserves more attention from the scientific community and from policy makers [23][24][25]. The effect of aging over autonomic dysfunction should also be thoroughly scrutinized.…”