Abstract
Background: In the apparent indeterminate form of Chagas' disease, which lacks any overt clinical,
electrocardiographic, and radiological manifestations of organ damage, lesions of
the intrinsic autonomic innervation of heart are not striking features and evidences
for cardiac autonomic dysfunction are elusive and conflicting. Objective: To evaluate the cardiac autonomic modulation based on Valsalva manoeuvre-associated
heart interval variation in Chagas' disease subjects with apparent indeterminate form.
Subjects and methods: We examined 36 outpatient volunteers aged 15–51 years old (median: 36.5), in comparison
with 52 healthy control individuals aged 17–49 years old (median: 29) (p<0.001). Each subject sequentially performed in the supine position three to four
manoeuvres at an intra-oral pressure of 40 mm Hg during 20 s, under continuous DII
lead electrocardiographic registration, and rate- and time-dependent indices of Valsalva
manoeuvre-associated R–R interval variation were obtained. The t-test or the Mann–Whitney test was employed to compare the data between the groups.
Results: No correlation was found between every index and age for the control group (p=0.39–0.71). The chagasic group presented similar basal to phase IV median increment
(relative bradycardia) (23.7% vs. 22.7%; p=0.63) and smaller basal to phase III median decrement of R–R interval (relative tachycardia)
(−31.7% vs. −35%; p=0.02) in comparison to the control group, respectively. The median Valsalva ratio
showed a tendency for reduction in chagasics (1.78 vs. 1.90; p=0.08). Prolonged median time (14.2 vs. 10.3 s; p<0.001) and slowed median velocity (5.1%/s vs. 8.9%/s; p<0.001) of the phases III–IV bradycardia were also observed in chagasic group. The
majority (58.3%) of the chagasics presented exclusively at least one depressed, and
8.3% presented at least one enhanced index of rate- and/or time-dependent heart interval
responses beyond the 25th or 75th control percentiles, and 27.8% presented at least
one depressed and other enhanced index, while 5.6% showed all indices within the control
interquartile range. All the indices outside the 25th or 75th control percentiles
were noted in 13.9% of chagasics. Conclusion: Chagas' disease subjects without overt manifestations presented variable and subtle
depression and less frequent enhancement or normality of the rate- and time-dependent
tachycardia and bradycardia reflex responses related to Valsalva manoeuvre, which
demonstrates distinct patterns of finely disturbed cardiac sinus parasympathetic and
sympathetic modulation, probably due to inflammatory or autoimmunological damage of
intrinsic innervation and/or to autoantibodies-induced derangement in neurotransmitter
receptors.
Keywords
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Article info
Publication history
Accepted:
January 14,
2002
Received in revised form:
December 10,
2001
Received:
August 9,
2001
Identification
Copyright
© 2002 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
