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

Ribeiro, Antônio Luiz Pinho; Cassini, Paula; Peixoto, Sérgio Viana; Lima‐Costa, Maria Fernanda

doi:10.1016/j.ijcard.2009.10.002

Cited by 9 publications

(9 citation statements)

References 34 publications

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“…However, a sample of elderly chagasics with the indeterminate form of the disease did not showed any alterations in cardiac autonomic function as compared with healthy elderly subjects 40 . Contrasting with this finding, elderly chagasics below 70 years, but not those older, with an uncharacterised form of the disease, show reduced vagal modulation 41 .…”

Section: Cardiac Autonomic Nervous System In Chagas Diseasecontrasting

confidence: 64%

“…Depressed sensitivity of the baroreflex mechanism resulting in blunted bradycardia or tachycardia in response to acute elevation or reduction of arterial pressure has been observed 32,77 , as have altered baroreflex responses traduced by deficient heart rate responses during and after the Valsalva manoeuvre in chagasics with any form of the disease 8,33,36,78,79 . Additionally, moment-to-moment heart rate variability is variably depressed in chagasic subjects both in supine and standing positions 9,10,39,41,46,68,80 . These autonomic cardiovascular disturbances occur most often in chagasics with exclusive or combined heart disease.…”

Section: Disturbed Cardiovascular Homeostatic Neural Regulationmentioning

confidence: 99%

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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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Section: Cardiac Autonomic Nervous System In Chagas Diseasecontrasting

confidence: 64%

Section: Disturbed Cardiovascular Homeostatic Neural Regulationmentioning

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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“…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.…”

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confidence: 99%

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

Lima‐Costa

Peixoto

Ribeiro

2010

International Journal of Cardiology

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Earlier studies of the natural history of Chagas disease (ChD), which is caused by the protozoan Trypanosoma cruzi, had suggested that the consequences of the disease in the elderly are negligible. The objective of this study was to estimate long-term mortality in ChD in old age using data from a large population-based cohort study. The study was conducted in Bambui City (~15,000 inhabitants), Brazil. Participants were 1479 residents aged 60 years and over (84.9% from total), who were followed from 1997 to 2007. During a mean follow-up of 8.72 years, 567 participants died, resulting in a total of 12,896 person-years observation. The baseline prevalence of T. cruzi infection was 38.1%. T. cruzi infection was a strong predictor of mortality among cohort members, and this association remained largely significant after adjustments for age, sex, and conventional cardiovascular risk factors (hazard ratio [HR] = 1.56; 95% CI 1.32-1.85). Increased risks for mortality associated with T. cruzi infection were consistently observed in those aged 60-69 (HR= 1.79; 95%CI 1.37-1.85), 70-79 (HR=1.35; 95% CI 1.04-1.76) and 80 years and over (HR= 1.59; 95% CI 1.09-2.33). Overall, population attributable risk for mortality due to T. cruzi infection was 13.2% (95% CI 9.8-16.4). Our results indicate that ChD is a relevant individual and population health issue in old age, supporting the need for measures to reduce the burden of ChD in this growing segment of the population.

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“…Some of the less known HRV indices as well as the more common ones have been used to investigate autonomic dysfunction: RSA 5RRmc for assessing diabetes [53], Guillain-Barré syndrome [54], and sinus node dysfunction [55]; RMSSD for detecting vagal impairment in Chagas disease in 10 s [56]. Various cardiac conditions have been investigated with HRV.…”

Section: Other Indices and Their Short Term Usementioning

confidence: 99%

Heart rate variability indices for very short-term (30 beat) analysis. Part 1: survey and toolbox

Smith

Owen

Reynolds

2013

J Clin Monit Comput

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Heart rate variability (HRV) analysis over very short (<60 s) periods may be useful for monitoring dynamic changes in autonomic nervous system activity where steady-state conditions are not maintained (e.g. during drug administration, or the start or end of exercise). From the 1980s there has been a wealth of HRV indices produced in the quest for better measures of the change in parasympathetic and sympathetic activity. Many of the indices have been sparingly used and have not been investigated for application to short-term use. This study surveyed published methods of HRV analysis searching for indices that could be applied to very short time HRV analysis. The survey included measures of time domain, frequency domain, respiratory sinus arrhythmia, Poincaré plot, and heart rate characteristics. Indices were tested with short segments of archived data to remove those that produced invalid results, or were mathematically equivalent to, but less well known than other indices. The survey identified a comprehensive list of 115 indices that were subsequently coded and screened. Of these, 70 were unique and produced a finite number with 60 s data, so are included in the Toolbox. These indices require validation against physiological data before they can be applied to short-term HRV analysis of cardiac autonomic nervous system activity.

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

Abstract: 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.

Cited by 9 publications

References 34 publications

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

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

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

Heart rate variability indices for very short-term (30 beat) analysis. Part 1: survey and toolbox

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