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The relationship between heart rate variability and serum cytokines in chronic chagasic patients with persistent
Mauricio Llaguno1, Luiz Antonio Rodrigues de Resende Pertili, Marcos Vinicius da Silva
1Internal Medicine Department, Infectious Division, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
Insights
Chagas
Area of Science:
- Cardiology
- Immunology
- Infectious Diseases
Background:
- Persistent parasitemia and immune system dysfunction contribute to chronic Chagas' disease cardiovascular complications.
- Autonomic nervous system impairments are implicated in the progression of Chagas' disease.
- Understanding these factors is crucial for managing the chronic phase of Chagas' disease.
Purpose of the Study:
- To investigate autonomic nervous system function and serum cytokine profiles in patients with different forms of chronic Chagas' disease.
- To assess cardiovascular risk associated with autonomic dysfunction and immune markers.
- To differentiate between indeterminate and cardiac forms of Chagas' disease.
Main Methods:
- Evaluated 17 indeterminate (IChD) and 12 cardiac (ChHD) chronic Chagas' disease patients, plus 29 controls.
- Assessed parasitemia, heart rate variability (linear and nonlinear methods), and serum cytokines (ILs, TNF-α, IFN-γ).
- Utilized polymerase chain reaction, hemoculture, and enzyme-linked immune assay for analyses.
Main Results:
- Chagasic patients exhibited reduced heart rate variability compared to controls.
- Nonlinear heart rate variability indices indicated higher impairment in the cardiac (ChHD) group.
- ChHD patients showed elevated IL-10 and reduced IFN-γ levels compared to the indeterminate (IChD) group.
Conclusions:
- Both chagasic groups display autonomic dysfunction via linear heart rate variability analysis.
- Nonlinear analysis suggests increased cardiovascular risk in the cardiac Chagas' disease group.
- Distinct cytokine profiles (higher IL-10, lower IFN-γ) in ChHD patients suggest immune regulation processes.
Background:
Persistent parasitemia, immunological, and autonomic nervous system impairments may play an important role in the evolution and clinical outcome of the chronic phase of Chagas' disease by triggering functional cardiovascular changes.
Methods:
Three groups were evaluated: 17 chronic chagasic patients with the indeterminate form (IChD), 12 chronic chagasic patients with cardiac forms (ChHD), and 29 individuals as a healthy control group. Parasitemia was assessed by polymerase chain reaction; hemoculture, heart rate variability by linear and nonlinear methods, and interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-12, IL-13, IL-17, and tumor necrosis factor-α, and interferon (IFN)-γ serum cytokines were assessed by enzyme-linked immune assay.
Results:
Twenty-nine chronic chagasic patients were positive for parasitemia (17 IChD and 12 ChHD). Heart rate variability parameters in baseline condition and after cold face test were significantly decreased in chagasic patients compared to controls. Tilt tests showed no alteration. However, using nonlinear indices, ChHD patients presented lower values compared to IChD and controls. Differences in the expression of serum cytokines were observed between chagasic patients and controls. However, among the groups, ChHD presented higher median values of IL-10 and lower of IFN-γ compared to IChD.
Conclusion:
Both chagasic groups present an autonomic impairment using linear methods. The nonlinear methods revealed that the ChHD group had a higher cardiovascular risk. Serum cytokine concentrations between chagasic patients were similar. However, ChHD showed higher concentrations of IL-10 and lower of IFN-γ, suggesting some established process of immune regulation.
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