Davila D F, Bellabarba G, Hernandez L, Calmon G, Torres A, Donis J H, Barboza J S, Lemorvan C, Gonzalez J G
Centro de Investigaciones Cardiovasculares, Universidad de los Andes, Merida, Venezuela.
Int J Cardiol. 1995 Nov 24;52(2):145-51. doi: 10.1016/0167-5273(95)02459-a.
The functional status of the sympathetic nervous system in Chagas' heart disease is still the subject of intense controversy. To determine the nature of the abnormalities of the sympathetic nervous system, we measured the plasma norepinephrine concentration of chagasic patients with varying degrees of myocardial damage. Thirty-six patients with positive serology for Chagas' disease were studied. Twenty patients were in Functional Class I (New York Heart Association), 10 were in Functional Class II and six were in Functional Classes III-IV. Cardiac catheterization was performed in 24 patients. The asymptomatic patients had a plasma norepinephrine concentration (121 +/- 37 pg/ml, mean +/- S.D.) not different from normal controls (103 +/- 59 pg/ml). The symptomatic patients, however, had a significantly elevated plasma norepinephrine concentration (665 +/- 354 pg/ml, P < 0.001). The baseline heart rate of the asymptomatic and symptomatic patients directly correlated with the plasma norepinephrine concentration (r = 0.69, P < 0.0001). The symptomatic patients had larger ventricular volumes, higher left ventricular end-diastolic pressures and lower ejection fractions than the asymptomatic patients and normal controls. The plasma norepinephrine concentration correlated linearly with the left ventricular end-diastolic volume (r = 0.77, P < 0.0001), and non-linearly with the ejection fraction (r = -0.70, P < 0.0001) and the left ventricular end-diastolic pressure (r = 0.53, P < 0.007). These results indicate that, in Chagas' heart disease as in most other cardiac diseases, sympathetic nervous system activation is a late and compensatory phenomenon. In other words, sympathetic activation is very likely related to the progressive impairment of left ventricular function.
恰加斯心脏病中交感神经系统的功能状态仍是激烈争论的主题。为了确定交感神经系统异常的性质，我们测量了不同程度心肌损伤的恰加斯病患者的血浆去甲肾上腺素浓度。对36例恰加斯病血清学阳性的患者进行了研究。20例患者为纽约心脏协会心功能I级，10例为心功能II级，6例为心功能III - IV级。24例患者进行了心导管检查。无症状患者的血浆去甲肾上腺素浓度（121±37 pg/ml，均值±标准差）与正常对照组（103±59 pg/ml）无差异。然而，有症状患者的血浆去甲肾上腺素浓度显著升高（665±354 pg/ml，P<0.001）。无症状和有症状患者的基础心率与血浆去甲肾上腺素浓度直接相关（r = 0.69，P<0.0001）。有症状患者比无症状患者和正常对照组有更大的心室容积、更高的左心室舒张末期压力和更低的射血分数。血浆去甲肾上腺素浓度与左心室舒张末期容积呈线性相关（r = 0.77，P<0.0001），与射血分数呈非线性相关（r = -0.70，P<0.0001），与左心室舒张末期压力呈非线性相关（r = 0.53，P<0.007）。这些结果表明，在恰加斯心脏病中，与大多数其他心脏病一样，交感神经系统激活是一种晚期的代偿现象。换句话说，交感神经激活很可能与左心室功能的进行性损害有关。
