The Valsalva maneuver in Chagas disease patients without cardiopathy

Oliveira, Enilce; Ribeiro, Antônio Luiz Pinho; Silva, Fernando Assis; Torres, Renato A.; Rocha, Manoel Otávio Costa

doi:10.1016/s0167-5273(01)00599-x

Cited by 23 publications

(34 citation statements)

References 25 publications

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“…The active orthostatic stress test is sensitive, specific, reproducible, and easily performed, being con- Table I The results of the active orthostatic stress test in chagasic patients with no heart disease, as compared with that in normal controls, confirm the findings of our previous study performed in the same group of patients [4][5][6] , and in another sample later studied 7,8 , and also the findings reported by other authors [24][25][26][27] . The different methods used, such as the variability in heart rate (assessed with different techniques) 5,7,8,22 , the Valsalva maneuver 6,23,24,26 , and respiratory sinus arrhythmia 5,26 , showed that autonomic dysfunction is present in patients with no evidence of heart disease and with preserved left ventricular function. The set of these results definitively answers a question that has pervaded the literature during the last 2 decades: whether autonomic dysfunction precedes or not left ventricular dysfunction in Chagas' disease [26][27][28][29][30] .…”

Section: Discussionsupporting

confidence: 85%

“…Autonomic dysfunction, a typical abnormality of the disease, has been implicated as playing an important role in the genesis of arrhythmic death in Chagas' disease 3 . Recent studies [4][5][6][7][8] have reported that vagal dysfunction can be observed in patients with no left ventricular dysfunction, occurring early in some patients with the disease. It can be recognized with the study of heart rate variability on 24-hour Holter, of respiratory sinus arrhythmia, and the Valsalva maneuver.…”

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confidence: 99%

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Estresse ortostático ativo e arritmia sinusal respiratória em chagásicos com função sistólica global do ventrículo esquerdo preservada

Ribeiro¹,

Ferreira²,

Oliveira³

et al. 2004

Arq. Bras. Cardiol.

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ResultsThe max RR/min RR ratio (NCh: 1.52 [1.44-1.74] x Ch: 1.43 [1.33-1.51], P < 0.001) and the E:I ratio (NCh: 1.38±0.02 x Ch: 1.25±0.02, P<0.001) were lower among chagasic patients. A high correlation was observed between the adjusted max RR/ min RR ratio and E:I ratio (r = 0.628, P < 0.001), but neither significantly correlated with left ventricular ejection fraction. ConclusionChagasic patients with preserved left ventricular overall systolic function showed a significant reduction in the vagal indices obtained on short-lasting tests, as compared with normal controls. The active orthostatic stress test that, showed a good correlation with the respiratory sinus arrhythmia maneuver, constituted a valid option for the outpatient care assessment of vagal control.

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Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

Estresse ortostático ativo e arritmia sinusal respiratória em chagásicos com função sistólica global do ventrículo esquerdo preservada

Ribeiro¹,

Ferreira²,

Oliveira³

et al. 2004

Arq. Bras. Cardiol.

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“…Autonomic balance assessment using the Valsalva maneuver has been widely used in chagasic patients (21) (30) (31) and showed no difference between the groups examined in the present study. Similarly, a recent meta-analysis (32) demonstrated that only one of the seven studies analyzed found a signifi cant difference in the Valsalva ratio between healthy individuals and chagasic patients without cardiopathy.…”

Section: Autonomic Balance In Chagas Disease Patientsmentioning

confidence: 45%

“…The Valsalva maneuver was performed according to Oliveira et al (21) . In brief, in the sitting position, the patient performed a valid maneuver by blowing, with the glottis closed, into a mouthpiece connected to an aneroid manometer by tubing in order to maintain an intraoral pressure of 40mmHg for 15s after a habitual inspiration.…”

Section: Autonomic Function Testsmentioning

confidence: 99%

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

Costa

Nunes

Souza

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Introduction: Exercise-induced ventricular arrhythmia (EIVA) and autonomic imbalance are considered as early markers of heart disease in Chagas disease (ChD) patients. The objective of the present study was to verify the differences in the occurrence of EIVA and autonomic maneuver indexes between healthy individuals and ChD patients with no apparent cardiac involvement. Methods: A total of 75 ChD patients with no apparent cardiac involvement, aged 44.7 (8.5) years, and 38 healthy individuals, aged 44.0 (9.2) years, were evaluated using echocardiography, symptom-limited treadmill exercise testing and autonomic function tests. Results: The occurrence of EIVA was higher in the chagasic group (48%) than in the control group (23.7%) during both the effort and the recovery phases. Frequent ventricular contractions occurred only in the patient group. Additionally, the respiratory sinus arrhythmia index was signifi cantly lower in the chagasic individuals compared with the control group. Conclusions: ChD patients with no apparent cardiac involvement had a higher frequency of EIVA as well as more vagal dysfunction by respiratory sinus arrhythmia. These results suggest that even when asymptomatic, ChD patients possess important arrhythmogenic substrates and subclinical disease.

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“…An electrocardiogram was performed, and the electrocardiogram recording was analyzed in a blinded fashion. The Valsalva ratio was calculated as the ratio of the longest R-R interval recorded during phase 4 to the shortest R-R interval recorded during phase 2 11 . For the RSA test, the subjects were instructed to breathe deeply at a rate of 6 cycles per minute with the help of a metronome, and the R-R interval was recorded with an electrocardiogram.…”

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confidence: 99%

Is autonomic function associated with left ventricular systolic function in Chagas heart disease patients undergoing treatment for heart failure?

Raadschilders

Rocha

Sousa

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Introduction:The association between cardiac autonomic and left ventricular (LV) dysfunction in Chagas disease (ChD) is controversial. Methods: A standardized protocol that includes the Valsalva maneuver, a respiratory sinus arrhythmia (RSA) test, and an echocardiographic examination was used. Spearman correlation coeffi cients (rho) were used to investigate associations. Results: The study population consisted of 118 ChD patients undergoing current medical treatment, with an average LV ejection fraction of 51.4±2.6%. The LV ejection fraction and diastolic dimension were correlated with the Valsalva index (rho=0.358, p<0.001 and rho=-0.266, p=0.004, respectively) and the RSA (rho=0.391, p<0.001 and rho=-0.311, p<0.001, respectively). Conclusions:The impairment of LV function is directly associated with a reduction of cardiac autonomic modulation in ChD.

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The Valsalva maneuver in Chagas disease patients without cardiopathy

Cited by 23 publications

References 25 publications

Estresse ortostático ativo e arritmia sinusal respiratória em chagásicos com função sistólica global do ventrículo esquerdo preservada

Estresse ortostático ativo e arritmia sinusal respiratória em chagásicos com função sistólica global do ventrículo esquerdo preservada

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

Is autonomic function associated with left ventricular systolic function in Chagas heart disease patients undergoing treatment for heart failure?

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