Alp. Ribeiro et al., Parasympathetic dysautonomia precedes left ventricular systolic dysfunction in Chagas disease, AM HEART J, 141(2), 2001, pp. 260-265
Citations number
22
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background Parasympathetic dysautonomia is an established feature of advanc
ed Chagas cardiomyopathy. How ever, in the absence of cardiac involvement,
the presence of vagal dysfunction remains controversial. In a cross-section
al study, we compared patients with Chagas disease without cardiac involvem
ent and healthy individuals by three different methods to determine whether
vagal dysfunction is present in the early phase of Chagas disease.
Methods Sixty-one patients with Chagas disease without cardiac involvement
and 38 controls were submitted to respiratory sinus arrhythmia test and 24-
hour Holter monitoring. Vagal heart influences were assessed by the expirat
ory/inspiratory (E/I) ratio, time-domain indexes of heart rate variability
(HRV), and by the quantification of a S-dimensional return map.
Results The two groups were comparable in terms of left ventricular ejectio
n fraction and left ventricular end-diastolic dimension. Compared with the
control group, patients with Chagas disease had significantly lower values
of the E/I ratio (mean +/- SD: 1.38 +/- 0.02 and 1.25 +/- 0.02, P < .004) a
nd short-term indexes of HRV (median [interquartile range]-rMSSD: 23 [18-27
] and 17 [13-23], P = .00; pNN50: 11 [7-17] and 6 [2-12], P = .00). P-3, a
beat-to-beat HRV index derived from the 3-dimensional return map, also was
significantly reduced in the Chagas disease group (mean +/- SD: 118 +/- 5 v
s 100 +/- 4, P = .00). None of these indexes of vagal heart control were si
gnificantly correlated with left ventricular function or to the presence of
esophageal radiologic abnormalities.
Conclusion Parasympathetic dysautonomia is an independent and early phenome
non in Chagas disease and may precede left ventricular systolic dysfunction
.