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. 2022 Jul;119(1):3-11.
doi: 10.36660/abc.20210400.

Relationship between Urinary Norepinephrine, Fibrosis, and Arrhythmias in Chronic Chagas Heart Disease with Preserved or Mildly Reduced Ejection Fraction

[Article in English, Portuguese]
Eduardo Marinho Tassi  1 , Emília Matos do Nascimento  1 , Marcelo Abramoff Continentino  1 , Basilio de Bragança Pereira  1 , Roberto Coury Pedrosa  1
Affiliations

Relationship between Urinary Norepinephrine, Fibrosis, and Arrhythmias in Chronic Chagas Heart Disease with Preserved or Mildly Reduced Ejection Fraction

[Article in English, Portuguese]
Eduardo Marinho Tassi et al. Arq Bras Cardiol. 2022 Jul.

Abstract
in English, Portuguese

Background: In Chronic Chagas Cardiomyopathy (CCC), studies are needed to identify arrhythmogenic risk factors in patients in which moderate to severe ventricular dysfunction is not present.

Objective: To verify the correlation between frequent ventricular arrhythmias (PVC), left ventricular ejection fraction (LVEF), extension of fibrosis by cardiac magnetic resonance (CMR), and urinary norepinephrine measurement (NOREPI) in CCC with preserved or mildly compromised LVEF.

Methods: The presence of ventricular extrasystoles > 30/h was analyzed on Holter. At CMR, LVEF and quantification of fibrosis mass were evaluated. The dosage of NOREPI was performed using the Muskiet method. The correlation coefficient matrix was calculated to measure the predictive ability of the variables to predict another variable, with p < 0.05 being considered significant.

Results: A total of 59 patients were included. The mean age was 57.9 + 10.94 years. PVC was detected in 28 patients. The fibrosis variable was inversely proportional to LVEF (R of -0.61) and NOREPI (R of -0.68). Also, the variable PVC was inversely proportional to LVEF (R of -0.33) and NOREPI (R of -0.27). On the other hand, LVEF was directly proportional to NOREPI (R of 0.83).

Conclusion: In this sample, in patients with CCC with preserved or slightly reduced LVEF, integrity of the autonomic nervous system is observed in hearts with little fibrosis and higher LVEF despite the presence of traditional risk factors for sudden cardiac death. There is correlation between the levels of NOREPI, LVEF, and myocardial fibrosis, but not with PVC.

Fundamento: Na cardiomiopatia chagásica crônica (CCC), impõem-se estudos com a proposta de identificar fatores de risco arritmogênicos em pacientes nos quais a disfunção ventricular de moderada a grave não está presente.

Objetivos: Verificar a dependência entre arritmias ventriculares frequentes (ARV), fração de ejeção de ventrículo esquerdo (FEVE), extensão da fibrose pela ressonância magnética cardíaca (RMC) e dosagem de norepinefrina urinária (NOREPI) na CCC com FEVE preservada ou minimamente comprometida.

Métodos: Foi analisada no Holter a presença de extrassístoles ventriculares >30/hora. Na RMC, avaliou-se a FEVE e a quantificação de massa fibrosada. Foi realizada a dosagem de NOREPI pelo método de Muskiet. A matriz de correlação foi calculada para aferir a capacidade de as variáveis preverem outra sendo considerado significante p<0,05.

Resultados: Foram incluídos no estudo 59 pacientes, com idade média de 57,9±10,94 anos. Arritmia ventricular frequente (ARV) foi detectada em 28 pacientes. A variável fibrose mostrou-se inversamente proporcional à fração de ejeção de ventrículo esquerdo (FEVE) (R de −0,61) e à norepinefrina urinária (NOREPI) (R de −0,68), assim como a variável ARV mostrou-se inversamente proporcional à FEVE (R de −0,33) e à NOREPI (R de −0,27). Já a FEVE mostrou-se diretamente proporcional à NOREPI (R de 0,83).

Conclusão: Nesta amostra, em pacientes com CCC com FEVE preservada ou discretamente reduzida, observa-se a integridade do sistema nervoso autonômico em corações com pouca fibrose e FEVE mais elevada, apesar da presença de tradicionais fatores de risco para morte súbita cardíaca. Há dependência entre os níveis de NOREPI, FEVE e fibrose miocárdica, mas não com ARV.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo.

Figures

Figura 1
Figura 1. Modelo Log-Linear. Os pesos nas arestas correspondem à estatística Cramér's V (medida de dependência entre as variáveis discretas).
Figura 2
Figura 2. Matriz de Correlação (valores em R). Quanto mais ovalado melhor é a correlação. Os asteriscos representam a significância de acordo com o p-value.
(*** p < 0.001, ** p < 0.1, * p < 0.05).
Figure 1
Figure 1. Log-Linear Model. Edge weights correspond to the Cramér's V statistic (measure of dependence between discrete variables).
Figure 2
Figure 2. Correlation Coefficient Matrix (values in R). The more oval the better the correlation. Asterisks represent the significance according to the p-value. (*** p < 0.001, ** p < 0.1, * p < 0.05).
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