| dc.description | Background: The importance of regional sympathetic denervation in the pathophysiology and prognosis of Chagas
disease has been recognized.
Objective: To conduct a review of studies that have assessed dysautonomia in chronic Chagas heart disease.
Methods: The search was performed on the Medline, Pubmed, Lilacs and SciELO databases. The inclusion criteria
were: original articles published in full; studies on individuals with Chagas disease, that used diagnostic methods
for chagasic cardiomyopathy, and had clear inclusion and exclusion criteria. Duplicate studies, studies including
children (0 to 10 years old), studies involving animals, in vitro experiments, case reports, editorials, theses, and
dissertations were excluded.
Results: A total of 281 articles were retrieved, and 10 met the inclusion criteria and were analyzed. There was
great heterogeneity as to the technique for assessing dysautonomia, groups of patients studied and classification of
Chagas disease. The methods used for studying the autonomic system was immunohistochemistry (n=1), Valsalva
and tilt-test (n=1), scintigraphy (n=6) and Holter monitoring (n=2). The results indicated dysautonomia in the
indeterminate, digestive and cardiac forms of Chagas disease, and sympathetic denervation in the indeterminate
and cardiac forms of the disease. There was agreement between areas of denervation, hypoperfusion and fibrosis,
but areas of denervation were larger than those of hypoperfusion. The frequency of denervation and its extension
increased from the indeterminate to the cardiac form. There was an association between extension of denervation
and previous history of malignant ventricular arrhythmia.
Conclusions: The evidence presented in this review supports that an early diagnosis of autonomic denervation in
chronic Chagas' disease allows the identification of patients with an increased risk of sudden death. | |
