恰加斯病无症状患者的心率恢复情况。
Heart rate recovery in asymptomatic patients with Chagas disease.
作者信息
de Alencar Maria Clara Noman, Rocha Manoel Otávio da Costa, Lima Márcia Maria de Oliveira, Costa Henrique Silveira, Sousa Giovane Rodrigo, Carneiro Renata de Carvalho Bicalho, Silva Guilherme Canabrava Rodrigues, Brandão Fernando Vieira, Kreuser Lucas Jordan, Ribeiro Antonio Luiz Pinho, Nunes Maria Carmo Pereira
机构信息
Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
出版信息
PLoS One. 2014 Jun 30;9(6):e100753. doi: 10.1371/journal.pone.0100753. eCollection 2014.
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.
背景
患有右束支传导阻滞（RBBB）的恰加斯病患者临床表现和预后各异，这取决于左心室（LV）功能。自主神经功能紊乱可能是心脏受累的早期标志。运动后的心率恢复（HRR）可能提示自主神经功能障碍，这对治疗策略有影响。本研究旨在评估无症状的恰加斯病合并RBBB且无心室功能障碍患者在症状限制运动试验后的HRR，并与恰加斯病不确定型患者及健康对照进行比较。
方法
纳入149名受试者，分为3组。对照组由健康个体组成；第1组包括恰加斯病不确定型患者；第2组包括患有完全性RBBB伴或不伴左前分支阻滞且心室收缩功能正常的患者。进行症状限制运动试验并评估运动时的心率（HR）反应。HRR定义为运动峰值时的HR与试验结束后1分钟时的HR之差。
结果
健康个体与恰加斯病不确定型患者在运动期间的心率变化情况无差异，然而，与恰加斯病不确定型患者及对照组相比，RBBB患者变时性功能不全的发生率更高、运动能力更低且HRR更低。在17名患者（15%）中发现运动后HR下降延迟，恰加斯病不确定型患者中为9%，RBBB患者中为24%，这与年龄较大、功能能力较差、变时反应受损以及运动和恢复期间的室性心律失常有关。通过多变量分析，HRR下降延迟的独立预测因素为年龄（比值比[OR]1.11；95%置信区间[CI]1.03至1.21；p = 0.010）和RBBB的存在（OR 3.97；95%CI 1.05至15.01；p = 0.
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