Effects of exercise training on heart rate variability in Chagas heart disease

Bruno Ramos Nascimento, Márcia Maria Oliveira Lima, Maria do Carmo Pereira Nunes, Maria Clara Noman de Alencar, Henrique Silveira Costa, Marcelo Martins Pinto Filho, Vitor Emanuel Serafim Cota, Manoel Otávio da Costa Rocha, Antonio Luiz Pinho Ribeiro, Bruno Ramos Nascimento, Márcia Maria Oliveira Lima, Maria do Carmo Pereira Nunes, Maria Clara Noman de Alencar, Henrique Silveira Costa, Marcelo Martins Pinto Filho, Vitor Emanuel Serafim Cota, Manoel Otávio da Costa Rocha, Antonio Luiz Pinho Ribeiro

Abstract

Background: Heart rate variability (HRV) is a marker of autonomic dysfunction severity. The effects of physical training on HRV indexes in Chagas heart disease (CHD) are not well established.

Objective: To evaluate the changes in HRV indexes in response to physical training in CHD.

Methods: Patients with CHD and left ventricular (LV) dysfunction, physically inactive, were randomized either to the intervention (IG, N = 18) or control group (CG, N = 19). The IG participated in a 12-week exercise program consisting of 3 sessions/week.

Results: Mean age was 49.5 ± 8 years, 59% males, mean LVEF was 36.3 ± 7.8%. Baseline HRV indexes were similar between groups. From baseline to follow-up, total power (TP): 1653 (IQ 625 - 3418) to 2794 (1617 - 4452) ms, p = 0.02) and very low frequency power: 586 (290 - 1565) to 815 (610 - 1425) ms, p = 0.047) increased in the IG, but not in the CG. The delta (post - pre) HRV indexes were similar: SDNN 11.5 ± 30.0 vs. 3.7 ± 25.1 ms. p = 0.10; rMSSD 2 (6 - 17) vs. 1 (21 - 9) ms. p = 0.43; TP 943 (731 - 3130) vs. 1780 (921 - 2743) Hz. p = 0.46; low frequency power (LFP) 1.0 (150 - 197) vs. 60 (111 - 146) Hz. p = 0.85; except for high frequency power, which tended to increase in the IG: 42 (133 - 92) vs. 79 (61 - 328) Hz. p = 0.08).

Conclusion: In the studied population, the variation of HRV indexes was similar between the active and inactive groups. Clinical improvement with physical activity seems to be independent from autonomic dysfunction markers in CHD.

Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

References

    1. Nunes MC, Dones W, Morillo CA, Encina JJ, Ribeiro AL, Council on Chagas Disease of the Interamerican Society of Cardiology Chagas disease: an overview of clinical and epidemiological aspects. J Am Coll Cardiol. 2013;62(9):767–776.
    1. Biolo A, Ribeiro AL, Clausell N. Chagas cardiomyopathy: where do we stand after a hundred years? Prog Cardiovasc Dis. 2010;52(4):300–316.
    1. Ribeiro AL, Nunes MP, Teixeira MM, Rocha MO. Diagnosis and management of Chagas disease and cardiomyopathy. Nat Rev Cardiol. 2012;9(10):576–589.
    1. Rocha MO, Teixeira MM, Ribeiro AL. Anupdateonthe management of Chagas cardiomyopathy. Expert Rev Anti Infect Ther. 2007;5(4):727–743.
    1. Amaral da Silva Souza MV, Santos Soares CC, Rega de Oliveira J, Rosa de Oliveira C, Hargreaves Fialho P, Cunha DM, et al. Heart rate variability: analysis of time-domain indices in patients with chronic Chagas disease before and after an exercise program. Rev Port Cardiol. 2013;32(3):219–227.
    1. Resende LA, Carneiro AC, Ferreira BD, Silva RA, Silva VJ, Prata A, et al. Análise temporal da variabilidade da frequência cardíaca no estado basal em idosos chagásicos na forma indeterminada em área endêmica. Rev Soc Bras Med Trop. 2003;36(6):703–706.
    1. Guzzetti S, Iosa D, Pecis M, Bonura L, Prosdocimi M, Malliani A. Impaired heart rate variability in patients with chronic Chagas' disease. Pt 1Am Heart J. 1991;121(6):1727–1734.
    1. Ritt LE, Carvalho AC, Feitosa GS, Pinho-Filho JA, Andrade MV, Feitosa-Filho GS, et al. Cardiopulmonary exercise and 6-min walk tests as predictors of quality of life and long-term mortality among patients with heart failure due to Chagas disease. Int J Cardiol. 2013;168(4):4584–4585.
    1. Rocha AL, Lombardi F, da Costa Rocha MO, Barros MV, Val Barros Vda C, Reis AM, et al. Chronotropic incompetence and abnormal autonomic modulation in ambulatory Chagas disease patients. Ann Noninvasive Electrocardiol. 2006;11(1):3–11.
    1. Ribeiro AL, Gimenez LE, Hernandez CC, Carvalho AC, Teixeira MM, Guedes VC, et al. Early occurrence of anti-muscarinic autoantibodies and abnormal vagal modulation in Chagas disease. Int J Cardiol. 2007;117(1):59–63.
    1. Ribeiro AL, Moraes RS, Ribeiro JP, Ferlin EL, Torres RM, Oliveira E, et al. Parasympathetic dysautonomia precedes left ventricular systolic dysfunction in Chagas disease. Am Heart J. 2001;141(2):260–265.
    1. Bauer A, Barthel P, Schneider R, Ulm K, Muller A, Joeinig A, et al. Improved stratification of autonomic regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-risk) Eur Heart J. 2009;30(5):576–583.
    1. La Rovere MT, Pinna GD, Maestri R, Barlera S, Bernardinangeli M, Veniani M, et al. GISSI-HF Investigators Autonomic markers and cardiovascular and arrhythmic events in heart failure patients: still a place in prognostication? Datafromthe GISSI-HF trial. Eur J Heart Fail. 2012;14(12):1410–1419.
    1. Nascimento BR, Coelho TO, Ribeiro AL. Botoni FA, Dias FS. PROAMI. Programa de atualização em medicina intensiva. Porto Alegre: Artmed Panamericana; 2009. Variabilidade da frequência cardíaca em pacientes criticamente enfermos.
    1. Larsen AI, Gjesdal K, Hall C, Aukrust P, Aarsland T, Dickstein K. Effect of exercise training in patients with heart failure: a pilot study on autonomic balance assessed by heart rate variability. Eur J Cardiovasc Prev Rehabil. 2004;11(2):162–167.
    1. Iellamo F, Manzi V, Caminiti G, Sposato B, Massaro M, Cerrito A, et al. Dose-response relationship of baroreflex sensitivity and heart rate variability to individually-tailored exercise training in patients with heart failure. Int J Cardiol. 2013;166(2):334–339.
    1. Vasconcelos DF, Junqueira LF., Jr Distinctive impaired cardiac autonomic modulation of heart rate variability in chronic Chagas' indeterminate and heart diseases. J Electrocardiol. 2009;42(3):281–289.
    1. Sousa L, Rocha MO, Britto RR, Lombardi F, Ribeiro AL. Chagas disease alters the relationship between heart rate variability and daily physical activity. Int J Cardiol. 2009;135(2):257–259.
    1. Lima MM, Rocha MO, Nunes MC, Sousa L, Costa HS, Alencar MC, et al. A randomized trial of the effects of exercise training in Chagas cardiomyopathy. Eur J Heart Fail. 2010;12(8):866–873.
    1. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the heart failure association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur Heart J. 2008;29(19):2388–2442. Erratum in: Eur Heart J. 2010;12(4):416, Eur Heart J. 2010;31(5):624.
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories ATS Statement: guidelines for the six-minute test. Am J Respir Crit Care Med. 2002;166(1):111–117.
    1. Myers J. Principles of exercise prescription for patients with chronic heart failure. Heart Fail Rev. 2008;13(1):61–68.
    1. Ribeiro AL, Cassini P, Peixoto SV, Lima-Costa MF. Vagal impairment in elderly Chagas disease patients: a population-based study (the Bambui study) Int J Cardiol. 2011;147(3):359–365.
    1. Thiers CA, Barbosa JL, Pereira Bde B, Nascimento EM, Nascimento JH, Medei EH, et al. Autonomic dysfunction and anti-M2 and anti-beta 1 receptor antibodies in Chagas disease patients. Arq Bras Cardiol. 2012;99(2):732–739.
    1. Talvani A, Rocha MO, Ribeiro AL, Borda E, Sterin-Borda L, Teixeira MM. Levels of anti-M2 and anti-beta1 autoantibodies do not correlate with the degree of heart dysfunction in Chagas' heart disease. Microbes Infect. 2006;8(9-10):2459–2464.
    1. Ribeiro AL, Lombardi F, Sousa MR, Lins Barros MV, Porta A, Costa Val Barros V, et al. Power-law behavior of heart rate variability in Chagas' disease. Am J Cardiol. 2002;89(4):414–418.
    1. Villar JC, Leon H, Morillo CA. Cardiovascular autonomic function testing in asymptomatic T. cruzi carriers: a sensitive method to identify subclinical Chagas' disease. Int J Cardiol. 2004;93(2-3):189–195.
    1. Tundo F, Lombardi F, Rocha MC, Botoni F, Schmidt G, Barros VC, et al. Heart rate turbulence and left ventricular ejection fraction in Chagas disease. Europace. 2005;7(3):197–203.
    1. Vasconcelos DF, Junqueira LF., Jr Funções autonômica e mecânica ventricular na cardiopatia chagásica crônica assintomática. Arq Bras Cardiol. 2012;98:111–119.
    1. Davila DF, Inglessis G, Mazzei de Davila CA. Chagas' heart disease and the autonomic nervous system. Int J Cardiol. 1998;66(2):123–127.
    1. Molina RB, Matsubara BB, Hueb JC, Zanati SG, Meira DA, Cassolato JL, et al. Dysautonomia and ventricular dysfunction in the indeterminate form of Chagas disease. Int J Cardiol. 2006;113(2):188–193.
    1. Tanindi A, Olgun H, Celik B, Boyaci B. Heart rate variability in patients hospitalized for decompensated diastolic heart failure at admission and after clinical stabilization. Future Cardiol. 2012;8(3):473–482.
    1. Arsenos P, Gatzoulis K, Manis G, Gialernios T, Dilaveris P, Tsiachris D, et al. Decreased scale-specific heart rate variability after multi resolution wavelet analysis predicts sudden cardiac death in heart failure patients. Int J Cardiol. 2012;154(3):358–360.
    1. Ho YL, Lin C, Lin YH, Lo MT. The prognostic value of non-linear analysis of heart rate variability in patients with congestive heart failure: a pilot study of multiscale entropy. PloS One. 2011;6(4):
    1. McNarry MA, Lewis MJ. Heart rate variability reproducibility during exercise. Physiol Meas. 2012;33(7):1123–1133.
    1. Tannus LR, Sperandei S, Montenegro Júnior RM, Carvalho VR, Pedrosa HC, Félix MT, et al. Reproducibility of methods used for the assessment of autonomous nervous system's function. Auton Neurosci. 2013;177(2):275–279.
    1. Ginsburg P, Bartur G, Peleg S, Vatine JJ, Katz-Leurer M. Reproducibility of heart rate variability during rest, paced breathing and light-to-moderate intense exercise in patients one month after stroke. Eur Neurol. 2011;66(2):117–122.
    1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Committee for Practice Guidelines Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):803–869. Erratum in Eur J Heart Fail. 2013;15(3):361-2.
    1. Cipriano G Jr, Cipriano VT, da Silva VZ, Cipriano GF, Chiappa GR, de Lima AC, et al. Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis. Heart Fail Rev. 2013 Oct 16; [Epub ahead of print]
    1. Murad K, Brubaker PH, Fitzgerald DM, Morgan TM, Goff DC, Jr, Soliman EZ, et al. Exercise training improves heart rate variability in older patients with heart failure: a randomized, controlled, single-blinded trial. Congest Heart Fail. 2012;18(4):192–197.
    1. Routledge FS, Campbell TS, McFetridge-Durdle JA, Bacon SL. Improvements in heart rate variability with exercise therapy. Can Jo Cardiol. 2010;26(6):303–312.
    1. Fialho PH, Tura BR, Sousa AS, Oliveira CR, Soares CC, Oliveira JR, et al. Efeitos de um programa de exercícios sobre a capacidade funcional de pacientes com cardiopatia chagásica crônica, avaliados por teste cardiopulmonar. Rev Soc Bras Med Trop. 2012;45(2):220–224.

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