RESUMEN
BACKGROUND: The associations between autonomic function and biventricular function in patients with the indeterminate form of Chagas disease remains to be elucidated. METHODS: In 42 asymptomatic patients and 19 healthy volunteers, the autonomic function was assessed by time domain indices of heart rate variability (HRV), analyzed for 24 h; the right ventricular function was assessed by fraction area change, right ventricle shortening, and systolic excursion of the tricuspid valve; and the left ventricular function was assessed by ejection fraction and transmitral flow velocities. Data were expressed as mean+/-SD or medians (including the lower quartile and upper quartile). Groups were compared by Student's t or Mann-Whitney U test. Autonomic and ventricular function were correlated by Pearson's or Spearman's correlation coefficient. The level of significance was 5%. RESULTS: Right and left ventricular systolic function indexes were comparable between groups. Transmitral flow velocities were decreased in the Chagas disease group (p<0.05). The patients presented impaired HRV as indicated by the values of SDNN-day (80 (64-99) ms vs. 98 (78-127) ms; p=0.045), SDNNI-24 h (54 (43-71) vs. 65 (54-105) ms; p=0.027), SDNNI-day (49 (42-64) vs. 67 (48-76) ms; p=0.045), pNN50-day (2.2 (0.7-5)% vs. 10 (3-11)%; p=0.033); and pNN50-24 h (3 (1-7)% vs. 12 (8-19)%; p=0.013). There were no correlations between the left ventricular diastolic indices and autonomic dysfunctional indices (p>0.05). CONCLUSION: Patients with the indeterminate form of Chagas disease have both dysautonomia and left ventricular diastolic dysfunction. However, the right ventricular function is preserved. Importantly, ventricular diastolic dysfunction and dysautonomia are independent phenomena.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/etiología , Enfermedad de Chagas/complicaciones , Disfunción Ventricular/etiología , Adulto , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Enfermedad de Chagas/diagnóstico por imagen , Enfermedad de Chagas/fisiopatología , Ecocardiografía Doppler , Electrocardiografía Ambulatoria , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatologíaRESUMEN
O aparecimento de insuficiência cardíaca após infarto agudo do miocárdio é evento comum e está associado com aumento tanto da morbidade como da mortalidade. A insuficiência cardíaca pode aparecer em três fases distintas: pré-hospitalar, logo após o infarto e mais tardiamente, relacionada ao processo de remodelação ventricular. Nos últimos anos, foram introduzidos avanços terapêuticos importantes no tratamento da disfunção ventricular crônica após o infarto do miocárdio. Por outro lado, os avanços no tratamento agudo, na fase hospitalar, da insuficiência cardíaca após infarto foram bem menos significantes. Recentemente, entretanto, algumas estratégias vêm ganhando destaque e parecem ser promissoras para esses pacientes. Este artigo discute os principais aspectos da abordagem clínica dos pacientes com insuficiência cardíaca, na fase hospitalar após infarto agudo do miocárdio.