Dysautonomic Arrhythmogenesis: A Working Hypothesis in Chronic Chagas Cardiomyopathy

Pedrosa, Roberto Coury

doi:10.36660/ijcs.20200169

Cited by 3 publications

(3 citation statements)

References 70 publications

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“…Although ventricular fibrillation is causally associated with widespread cardiac fibrosis induced by the persistent infection by T. cruzi , cardiac dysautonomia is also likely to play an important role to trigger sudden death in patients with CCC. Although the intrinsic mechanism, whereby autonomic impairment increases susceptibility to life threatening arrhythmias is still unclear in CD, it is plausible to consider that it may lead to abnormal excitability and conductibility properties of cardiomyocytes [ 9 , 11 , 32 , 36 – 39 ]. Moreover, although impairment of parasympathetic control of the sinus node is well described in CD [ 40 , 41 ], the effects of cardiac denervation associated with the T. cruzi infection are more complex at the ventricular level.…”

Section: Discussionmentioning

confidence: 99%

“…This aspect is not directly evaluated in our study despite the plethora of indices assessing HRV, because they mostly reflect the autonomic control of the sinus node. Hence, although catecholamine-induced cardiomyopathy has not been technically proven to exist in the context of Chagas disease, a sympatho-vagal imbalance of the heart may configure an important factor for triggering sudden cardiac death [ 39 ]. In addition, studies of our group using MIBG-based techniques to assess the myocardial sympathetic system have shown striking abnormalities of catecholamine uptake that correlate with the intensity of malignant ventricular arrhythmia in patients with CCC [ 42 – 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score

et al. 2022

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Background Dysautonomia plays an ancillary role in the pathogenesis of Chronic Chagas Cardiomyopathy (CCC), but is the key factor causing digestive organic involvement. We investigated the ability of heart rate variability (HRV) for death risk stratification in CCC and compared alterations of HRV in patients with isolated CCC and in those with the mixed form (CCC + digestive involvement). Thirty-one patients with CCC were classified into three risk groups (low, intermediate and high) according to their Rassi score. A single-lead ECG was recorded for a period of 10–20 min, RR series were generated and 31 HRV indices were calculated. The HRV was compared among the three risk groups and regarding the associated digestive involvement. Four machine learning models were created to predict the risk class of patients. Results Phase entropy is decreased and the percentage of inflection points is increased in patients from the high-, compared to the low-risk group. Fourteen patients had the mixed form, showing decreased triangular interpolation of the RR histogram and absolute power at the low-frequency band. The best predictive risk model was obtained by the support vector machine algorithm (overall F1-score of 0.61). Conclusions The mixed form of Chagas' disease showed a decrease in the slow HRV components. The worst prognosis in CCC is associated with increased heart rate fragmentation. The combination of HRV indices enhanced the accuracy of risk stratification. In patients with the mixed form of Chagas disease, a higher degree of sympathetic autonomic denervation may be associated with parasympathetic impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score

et al. 2022

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“…240 Postula-se que tais anticorpos sejam resultantes do mimetismo antigênico (reação cruzada entre a proteína ribossomal P do T. cruzi e a proteína ribossomal humana), [241][242][243] sendo plausível conceber que tais distúrbios mediados por autoanticorpos circulantes possam conferir características particulares à disautonomia da DC, entre as outras afecções neuronais. 233,[244][245][246] 4.4. Fisiopatologia da Doença de Chagas Dependente de Características Genéticas Parasitárias e do Hospedeiro Humano O desenvolvimento de uma doença infecciosa é usualmente fenômeno complexo relacionado a vários fatores ambientais, do patógeno infectante e do hospedeiro.…”

Section: Alterações Do Sistema Nervoso Autonômico Na Doença De Chagas...unclassified

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Marin-Neto¹,

Rassi²,

Oliveira³

et al. 2023

Arquivos Brasileiros De Cardiologia

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Sudden cardiac death multiparametric classification system for Chagas heart disease's patients based on clinical data and 24-hours ECG monitoring

Cavalcante

Primo

Sales

et al. 2023

MBE

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<abstract><p>About 6.5 million people are infected with Chagas disease (CD) globally, and WHO estimates that $ > million people worldwide suffer from ChHD. Sudden cardiac death (SCD) represents one of the leading causes of death worldwide and affects approximately 65% of ChHD patients at a rate of 24 per 1000 patient-years, much greater than the SCD rate in the general population. Its occurrence in the specific context of ChHD needs to be better exploited. This paper provides the first evidence supporting the use of machine learning (ML) methods within non-invasive tests: patients' clinical data and cardiac restitution metrics (CRM) features extracted from ECG-Holter recordings as an adjunct in the SCD risk assessment in ChHD. The feature selection (FS) flows evaluated 5 different groups of attributes formed from patients' clinical and physiological data to identify relevant attributes among 57 features reported by 315 patients at HUCFF-UFRJ. The FS flow with FS techniques (variance, ANOVA, and recursive feature elimination) and Naive Bayes (NB) model achieved the best classification performance with 90.63% recall (sensitivity) and 80.55% AUC. The initial feature set is reduced to a subset of 13 features (4 Classification; 1 Treatment; 1 CRM; and 7 Heart Tests). The proposed method represents an intelligent diagnostic support system that predicts the high risk of SCD in ChHD patients and highlights the clinical and CRM data that most strongly impact the final outcome.</p></abstract>

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Dysautonomic Arrhythmogenesis: A Working Hypothesis in Chronic Chagas Cardiomyopathy

Cited by 3 publications

References 70 publications

Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score

Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Sudden cardiac death multiparametric classification system for Chagas heart disease's patients based on clinical data and 24-hours ECG monitoring

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