Plasma norepinephrine in Chagas' cardioneuromyopathy: A marker of progressive dysautonomia

Iosa, Daniel; DeQuattro, Vincent; Lee, Debora De-Ping; Elkayam, Uri; Palmero, H A

doi:10.1016/0002-8703(89)90627-3

Cited by 63 publications

(31 citation statements)

References 17 publications

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“…Specifically, authors have reported that intracardiac sympathetic overactivity seems to occur in patients with Chagas disease and chronic heart failure, 26 and that catecholamines levels are increased in patients with Chagas disease and correlated with disease severity, 27 suggesting that the sympathetic activity play a significant role in the disease progression. 11 In resonance with this rationale, our results do support the use of ␤-blockers therapy in patients with Chagas cardiomyopathy. Our findings are also in accord with results reported by other authors.…”

Section: Discussionsupporting

confidence: 69%

“…Specifically regarding the sympathetic nervous blockade, authors have reported lower levels of norepinephrine, 11 increased parasympathetic tonus (decreasing heart rate), decreased vagal modulation, 12 and bradycardia 13 in patients with Chagas disease. Although some reports indicate that patients with Chagas may benefit from ␤-blocker treat-ment, 14 -16 the inclusion of a small number of patients, retrospective analysis, presence of selection bias, and use of surrogate end points prevents a final conclusion.…”

Section: Clinical Perspective On P 88mentioning

confidence: 99%

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β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

Issa

Amaral

Cruz

et al. 2010

Circ: Heart Failure

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Background-Peculiar aspects of Chagas cardiomyopathy raise concerns about efficacy and safety of sympathetic blockade. We studied the influence of ␤-blockers in patients with Chagas cardiomyopathy. Methods and Results-We examined REMADHE trial and grouped patients according to etiology (Chagas versus non-Chagas) and ␤-blocker therapy. Primary end point was all-cause mortality or heart transplantation. Altogether 456 patients were studied; 27 (5.9%) were submitted to heart transplantation and 202 (44.3%) died. compared with those who received ␤-blockers. Survival was lower in patients with Chagas heart disease as compared with other etiologies. When only patients under ␤-blockers were considered, the survival of patients with Chagas disease was similar to that of other etiologies. The survival of patients with ␤-blockers was higher than that of patients without ␤-blockers. In Cox regression model, left ventricle end-diastolic diameter (hazard ratio, 1.78; CI, 1.15 to 2.76; Pϭ0.009) and ␤-blockers (hazard ratio, 0.37; CI, 0.14 to 0.97; Pϭ0.044) were associated with better survival. Conclusions-Our study suggests that ␤-blockers may have beneficial effects on survival of patients with heart failure and Chagas heart disease and warrants further investigation in a prospective, randomized trial. Clinical Trial Registration-clinicaltrials.gov. Identifier: NCT00505050.(Circ Heart Fail. 2010;3:82-88.)

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Section: Discussionsupporting

confidence: 69%

Section: Clinical Perspective On P 88mentioning

confidence: 99%

β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

Issa

Amaral

Cruz

et al. 2010

Circ: Heart Failure

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“…Patients with Chagas induced CHF had lower plasma CA levels related to Chagasic denervation. 26 The higher the level of CA in CHF, the higher the SNS influence and the poorer the prognosis. Drugs such as carvedilol and metoprolol can block and shield the way of sympathetic influence and allow the myocyte to come back more to its adult function.…”

Section: Noradrenergic Genesis Of Ischaemic Heart Disease and Chfmentioning

confidence: 99%

The sympathetic nervous system: the muse of primary hypertension

DeQuattro

Feng

2002

J Hum Hypertens

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the sympathetic neurotransmitter noradrenaline (NA) and postulated that excessive neural tone was a cause of primary hypertension (PH). Thirty years ago, we found raised NA levels in 30-40% of young patients with PH. Laragh found plasma renin activity (PRA) a risk marker for coronary artery disease. With Esler, Miura, and Campese, a close association was found of plasma NA with PRA. We found raised tyrosine hydroxylase activity (AC) in the hearts of a rabbit model of sinoaortic denervated hypertension and in PH with raised plasma NA. Esler utilised titrated NA infusion and described increased spillover of NA from heart, kidney and subcortical areas of brain of patients with PH. With Eide we found raised cerebrospinal fluid (CSF) NA in PH (not secondary hypertension) and with Kolloch and Miura, we found raised plasma/CSF NA in conjunction with reduced dopaminergic tone. With Shkvatsabaya, Yurenev and Davison, we found that relaxation therapy improved the

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“…Of note is that alterations in parasympathetic function in seropositive patients antedate the onset of clinically significant myocardial dysfunction (89). Abnormalities in the sympathetic component of the autonomic nervous system in chagasic patients, as reflected in the apparent reduction in levels of plasma norepinephrine (112), and a reduction in diastolic blood pressure in the upright position have been reported.…”

Section: Autonomic Nervous System In Chagas' Diseasementioning

confidence: 99%

Chagas' disease

et al. 1992

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Chagas' disease, caused by Trypanosoma cruzi, is an important cause of morbidity in many countries in Latin America. The important modes of transmission are by the bite of the reduviid bug and blood transfusion. The organism exists in three morphological forms: trypomastigotes, amastigotes, and epimastigotes. The mechanism of transformation and differentiation is currently being explored, and signal transduction pathways of the parasites may be involved in this process. Parasite adherence to and invasion of host cells is a complex process involving complement, phospholipase, penetrin, neuraminidase, and hemolysin. Two clinical forms of the disease are recognized, acute and chronic. During the acute stage pathological damage is related to the presence of the parasite, whereas in the chronic stage few parasites are found. In recent years the roles of tumor necrosis factor, gamma interferon, and the interleukins in the pathogenesis of this infection have been reported. The common manifestations of chronic cardiomyopathy are arrhythmias and thromboembolic events. Autoimmune, neurogenic, and microvascular factors may be important in the pathogenesis of the cardiomyopathy. The gastrointestinal tract is another important target, and "mega syndromes" are common manifestations. The diagnosis and treatment of this infection are active areas of investigation. New serological and molecular biological techniques have improved the diagnosis of chronic infection. Exacerbations of T. cruzi infection have been reported for patients receiving immuno-suppressive therapy and for those with AIDS.

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Plasma norepinephrine in Chagas' cardioneuromyopathy: A marker of progressive dysautonomia

Cited by 63 publications

References 17 publications

β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

β-Blocker Therapy and Mortality of Patients With Chagas Cardiomyopathy

The sympathetic nervous system: the muse of primary hypertension

Chagas' disease

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