Chronotropic Incompetence and Abnormal Autonomic Modulation in Ambulatory Chagas Disease Patients

Rocha, Ana Luiza Lunardi; Lombardi, Federico; Rocha, Manoel Otávio da Costa; Barros, Márcio Vinícius Lins; Barros, Vladimir da Costa Val; Reis, Adelina Martha dos; Ribeiro, Antônio Luiz Pinho

doi:10.1111/j.1542-474x.2006.00054.x

Cited by 38 publications

(30 citation statements)

References 30 publications

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“…In agreement with previous studies that addressed chronic Chagas patients with preserved ventricular function, this study shows that, whereas there is still parasympathetic activity evoked by respiratory sinus arrhythmia in this group of patients, they have lower vagal reserve in relation to controls [27][28][29]32 . This reduction in vagal reserve was not accompanied by changes in basal heart rate of the patient.…”

Section: Discussionsupporting

confidence: 79%

Disfunção autonômica e anticorpos contra receptores anti-m2 e anti-β1 em pacientes chagásicos

Thiers¹,

Barbosa²,

Pereira³

et al. 2012

Arq. Bras. Cardiol.

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Section: Discussionsupporting

confidence: 79%

Disfunção autonômica e anticorpos contra receptores anti-m2 e anti-β1 em pacientes chagásicos

Thiers¹,

Barbosa²,

Pereira³

et al. 2012

Arq. Bras. Cardiol.

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“…Deficient chronotropic responses have been noted during both dynamic 57,72 and isometric 73 exercise in chagasics with heart disease. The inability to achieve adequate tachycardia and blood pressure stabilisation upon standing has also been demonstrated [74][75][76] .…”

Section: Disturbed Cardiovascular Homeostatic Neural Regulationmentioning

confidence: 99%

“…These evidences include the demonstration that contractile alteration of the right ventricle is independent of autonomic dysfunction 34 , parasympathetic impairment precedes the left ventricular systolic dysfunction 35 , and that chronotropic incompetence in response to exercise testing is an early warning of cardiac autonomic disturbance that is independent of ventricular function 57 . In addition, we observed pronounced sympathetic and parasympathetic depression with preserved sympathovagal balance as evaluated by short-term heart rate variability, which occurred with virtually unaltered morphological and functional ventricular echocardiographic parameters.…”

Section: Junqueira Jr Lf -Significance Of Cardiac Autonomic Dysfunctimentioning

confidence: 99%

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Junqueira Junior

2012

Rev. Soc. Bras. Med. Trop.

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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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“…These autoantibodies trigger physiological, morphological, enzymatic, and molecular alterations. In addition, they could cause quantitative alterations in adrenergic and cholinergic receptors and, consequently, potential myocardial damage due to the cardiac autonomic dysfunctions known to occur in Chagasic cardiomyopathy (Hernandez et al, 2008;Ribeiro et al, 2009a;Rocha et al, 2006a;Rocha et al, 2006b). The clinical consequence of parasympathetic denervation is the absence of mechanisms, mediated by the vagus nerve, that trigger bradycardia or tachycardia in response to transient changes in blood pressure or venous return (Miziara et al, 2006;Ribeiro et al, 2009a;Rocha et al, 2009;Rocha et al, 2006b).…”

Section: Cardiac Disautonomiamentioning

confidence: 99%

Chagas disease: Present status of pathogenic mechanisms and chemotherapy

et al. 2010

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There are approximately 7.8 million people in Latin America, including Chile, who suffer from Chagas disease and another 28 million who are at risk of contracting it. Chagas is caused by the flagellate protozoan Trypanosoma cruzi. It is a chronic disease, where 20%-30% of infected individuals develop severe cardiopathy, with heart failure and potentially fatal arrhythmias. Currently, Chagas disease treatment is more effective in the acute phase, but does not always produce complete parasite eradication during indeterminate and chronic phases. At present, only nifurtimox or benznidazole have been proven to be superior to new drugs being tested. Therefore, it is necessary to find alternative approaches to treatment of chronic Chagas. The current treatment may be rendered more effective by increasing the activity of anti-Chagasic drugs or by modifying the host's immune response. We have previously shown that glutathione synthesis inhibition increases nifurtimox and benznidazole activity. In addition, there is increasing evidence that cyclooxygenase inhibitors present an important effect on T. cruzi infection. Therefore, we found that aspirin reduced the intracellular infection in RAW 264.7 cells and, decreased myocarditis extension and mortality rates in mice. However, the long-term benefit of prostaglandin inhibition for Chagasic patients is still unknown.

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Chronotropic Incompetence and Abnormal Autonomic Modulation in Ambulatory Chagas Disease Patients

Abstract: Chronotropic incompetence may be considered an early sign of autonomic dysfunction in ChD patients.

Cited by 38 publications

References 30 publications

Disfunção autonômica e anticorpos contra receptores anti-m2 e anti-β1 em pacientes chagásicos

Disfunção autonômica e anticorpos contra receptores anti-m2 e anti-β1 em pacientes chagásicos

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Chagas disease: Present status of pathogenic mechanisms and chemotherapy

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