Heart rate recovery in asymptomatic patients with Chagas disease.
BACKGROUND: Chagas disease patients with right bundle-branch block (RBBB) have diverse clinical presentation and prognosis, depending on left ventricular (LV) function. Autonomic disorder can be an early marker of heart involvement. The heart rate recovery (HRR) after exercise may identify autonomic...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4076274?pdf=render |
| _version_ | 1818863488218431488 |
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| author | Maria Clara Noman de Alencar Manoel Otávio da Costa Rocha Márcia Maria de Oliveira Lima Henrique Silveira Costa Giovane Rodrigo Sousa Renata de Carvalho Bicalho Carneiro Guilherme Canabrava Rodrigues Silva Fernando Vieira Brandão Lucas Jordan Kreuser Antonio Luiz Pinho Ribeiro Maria Carmo Pereira Nunes |
| author_facet | Maria Clara Noman de Alencar Manoel Otávio da Costa Rocha Márcia Maria de Oliveira Lima Henrique Silveira Costa Giovane Rodrigo Sousa Renata de Carvalho Bicalho Carneiro Guilherme Canabrava Rodrigues Silva Fernando Vieira Brandão Lucas Jordan Kreuser Antonio Luiz Pinho Ribeiro Maria Carmo Pereira Nunes |
| author_sort | Maria Clara Noman de Alencar |
| collection | DOAJ |
| description | BACKGROUND: Chagas disease patients with right bundle-branch block (RBBB) have diverse clinical presentation and prognosis, depending on left ventricular (LV) function. Autonomic disorder can be an early marker of heart involvement. The heart rate recovery (HRR) after exercise may identify autonomic dysfunction, with impact on therapeutic strategies. This study was designed to assess the HRR after symptom-limited exercise testing in asymptomatic Chagas disease patients with RBBB without ventricular dysfunction compared to patients with indeterminate form of Chagas disease and healthy controls. METHODS: One hundred and forty-nine subjects divided into 3 groups were included. A control group was comprised of healthy individuals; group 1 included patients in the indeterminate form of Chagas disease; and group 2 included patients with complete RBBB with or without left anterior hemiblock, and normal ventricular systolic function. A symptom-limited exercise test was performed and heart rate (HR) response to exercise was assessed. HRR was defined as the difference between HR at peak exercise and 1 min following test termination. RESULTS: There were no differences in heart-rate profile during exercise between healthy individuals and patients in indeterminate form, whereas patients with RBBB had more prevalence of chronotropic incompetence, lower exercise capacity and lower HRR compared with patients in indeterminate form and controls. A delayed decrease in the HR after exercise was found in 17 patients (15%), 9% in indeterminate form and 24% with RBBB, associated with older age, worse functional capacity, impaired chronotropic response, and ventricular arrhythmias during both exercise and recovery. By multivariable analysis, the independent predictors of a delayed decrease in the HRR were age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.03 to 1.21; p = 0.010) and presence of RBBB (OR 3.97; 95% CI 1.05 to 15.01; p = 0.042). CONCLUSIONS: A small proportion (15%) of asymptomatic Chagas patients had attenuated HRR after exercise, being more prevalent in patients with RBBB compared with patients in indeterminate form and controls. |
| first_indexed | 2024-12-19T10:16:33Z |
| format | Article |
| id | doaj.art-dc42209568744fc180621211c077fe69 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-19T10:16:33Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-dc42209568744fc180621211c077fe692022-12-21T20:26:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0196e10075310.1371/journal.pone.0100753Heart rate recovery in asymptomatic patients with Chagas disease.Maria Clara Noman de AlencarManoel Otávio da Costa RochaMárcia Maria de Oliveira LimaHenrique Silveira CostaGiovane Rodrigo SousaRenata de Carvalho Bicalho CarneiroGuilherme Canabrava Rodrigues SilvaFernando Vieira BrandãoLucas Jordan KreuserAntonio Luiz Pinho RibeiroMaria Carmo Pereira NunesBACKGROUND: Chagas disease patients with right bundle-branch block (RBBB) have diverse clinical presentation and prognosis, depending on left ventricular (LV) function. Autonomic disorder can be an early marker of heart involvement. The heart rate recovery (HRR) after exercise may identify autonomic dysfunction, with impact on therapeutic strategies. This study was designed to assess the HRR after symptom-limited exercise testing in asymptomatic Chagas disease patients with RBBB without ventricular dysfunction compared to patients with indeterminate form of Chagas disease and healthy controls. METHODS: One hundred and forty-nine subjects divided into 3 groups were included. A control group was comprised of healthy individuals; group 1 included patients in the indeterminate form of Chagas disease; and group 2 included patients with complete RBBB with or without left anterior hemiblock, and normal ventricular systolic function. A symptom-limited exercise test was performed and heart rate (HR) response to exercise was assessed. HRR was defined as the difference between HR at peak exercise and 1 min following test termination. RESULTS: There were no differences in heart-rate profile during exercise between healthy individuals and patients in indeterminate form, whereas patients with RBBB had more prevalence of chronotropic incompetence, lower exercise capacity and lower HRR compared with patients in indeterminate form and controls. A delayed decrease in the HR after exercise was found in 17 patients (15%), 9% in indeterminate form and 24% with RBBB, associated with older age, worse functional capacity, impaired chronotropic response, and ventricular arrhythmias during both exercise and recovery. By multivariable analysis, the independent predictors of a delayed decrease in the HRR were age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.03 to 1.21; p = 0.010) and presence of RBBB (OR 3.97; 95% CI 1.05 to 15.01; p = 0.042). CONCLUSIONS: A small proportion (15%) of asymptomatic Chagas patients had attenuated HRR after exercise, being more prevalent in patients with RBBB compared with patients in indeterminate form and controls.http://europepmc.org/articles/PMC4076274?pdf=render |
| spellingShingle | Maria Clara Noman de Alencar Manoel Otávio da Costa Rocha Márcia Maria de Oliveira Lima Henrique Silveira Costa Giovane Rodrigo Sousa Renata de Carvalho Bicalho Carneiro Guilherme Canabrava Rodrigues Silva Fernando Vieira Brandão Lucas Jordan Kreuser Antonio Luiz Pinho Ribeiro Maria Carmo Pereira Nunes Heart rate recovery in asymptomatic patients with Chagas disease. PLoS ONE |
| title | Heart rate recovery in asymptomatic patients with Chagas disease. |
| title_full | Heart rate recovery in asymptomatic patients with Chagas disease. |
| title_fullStr | Heart rate recovery in asymptomatic patients with Chagas disease. |
| title_full_unstemmed | Heart rate recovery in asymptomatic patients with Chagas disease. |
| title_short | Heart rate recovery in asymptomatic patients with Chagas disease. |
| title_sort | heart rate recovery in asymptomatic patients with chagas disease |
| url | http://europepmc.org/articles/PMC4076274?pdf=render |
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