Disfunção autonômica e Doença de Chagas: o que sabemos e o que precisamos saber para integrar a prática clínica
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Jul 18, 2025
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Objetivo: Fornecer uma visão geral, abrangente e atualizada da ação do sistema nervoso autônomo na doença de Chagas e a validação da Variabilidade da Frequência Cardíaca (VFC) como uma ferramenta para avaliar o sistema nervoso autônomo na doença de Chagas. Métodos: Esta revisão foi baseada em uma pesquisa nas bases de dados da Scientific Electronic Library Online (SCIELO) e PUBMED entre maio e dezembro de 2023, usando os termos doença de Chagas e variabilidade da frequência cardíaca entre 2011 e 2023. Resultados: O Sistema Nervoso Autônomo (SNA) tem sido amplamente analisado em relação à doença de Chagas. Esses achados caracterizam uma cardiopatia com privação parassimpática e predominância simpática. A variabilidade da frequência cardíaca (VFC) investiga as oscilações nos intervalos entre batimentos cardíacos consecutivos (intervalos RR), que estão seguramente relacionadas à influência do SNA no nó sinusal em um determinado período de tempo. Considerações finaisA disfunção do sistema nervoso autônomo é um dos principais mecanismos de lesão na doença de Chagas, e a variabilidade da frequência cardíaca é uma das formas de detectar essa condição. Entretanto, o uso da variabilidade da frequência cardíaca deve ser incorporado à prática clínica para a avaliação de pacientes diagnosticados com doença de Chagas.
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SilvaM. R. H. da S. e, SousaD. R. T. de, OrtizJ. V., Guevara-MoctezumaE. I., SilvaM. R. S. e, CouceiroK. do N., AreasG. P. T., GuerraJ. A. de O., GuerraM. das G. V. B., & FerreiraJ. M. B. B. (2025). Disfunção autonômica e Doença de Chagas: o que sabemos e o que precisamos saber para integrar a prática clínica. Revista Eletrônica Acervo Saúde, 25(7), e20412. https://doi.org/10.25248/reas.e20412.2025
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Referências
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2. ALENCAR MC, et al. Heart rate recovery in asymptomatic patients with Chagas disease. PLoS One, 2014; 9(6): 100753.
3. BARIZON GC, et al. Relationship between microvascular changes, autonomic denervation, and myocardial fibrosis in Chagas cardiomyopathy: Evaluation by MRI and SPECT imaging. J Nucl Cardiol, 2020; 27(2): 434-44.
4. BELEIGOLI AM, et al. Anthropometric measures and vagal indexes of heart rate variability in a population with high prevalence of Chagas Disease – differences according to obesity status. Intern J Cardiol, 2012; 156(1): 113-115.
5. BELTRAME SP, et al. Impairment of agonist-induced M2 muscarinic receptor activation by autoantibodies from chagasic patients with cardiovascular dysautonomia. Clin Immunol, 2020; 212: 108346.
6. BESTETTI RB, et al. Carlos Chagas discoveries as a drop back to scientific construction of construction of Chronic Chagas Heart Disease. Arq Bras Cardiol, 2016; 107(1): 63-70.
7. CATAI AM, et al. Heart rate variability: are you using properly? Standardization checklist of procedures. Brazilian Journal of Physical Therapy, 2020: 24 (2): 91-102.
8. CHADALAWADA S, et al. Risk of chronic cardiomyopathy among patients with the acute phase or indeterminate form of Chagas disease: a systematic review and meta-analysis. JAMA Netw Open, 2020;3(8): 2015072.
9. CHEVILLARD C, et al. Disease tolerance and pathogen resistance genes may underlie Trypanosoma cruzi persistence and differential progression to Chagas disease cardiomyopathy. Front Immunol, 2018; 9: 2791.
10. DABARIAN AL, et al. Dysregulation of insulin levels in Chagas Heart Disease is associated with altered adipocytokines levels. Can J Physiol Pharmacol, 2019; 97(2): 140-145.
11. DALIRY A, et al. Levels of circulating anti-muscarinic and anti-adrenergic antibodies and their effect on cardiac arrhythmias and dysautonomia in murine models of Chagas disease. Parasitology, 2014; 141(13): 1769-78.
12. FERREIRA JMBB, et al. Chronic Chagasic Cardiopathy in Amazon Region: an etiology to remember. Arq Bras. Cadiol, 2009; 93(6): 93-95.
13. FERREIRA JMBB, et al. Dysregulation of autonomic nervous system in Chagas’ heart disease is associated with altered adipocytokines levels. PLOS One, 2015; 10(7): 131447.
14. FERREIRA, JMBB. Pathophysiology and new targets for therapeutic options in Chagas heart disease. Mem Inst Oswaldo Cruz, 2022;117: 210172.
15. GUEDES PM, et al. Deficient regulatory T cell activity and low frequency of IL-17- producing T cells correlate with the extent of cardiomyopathy in human Chagas' disease. PLoS Negl Trop Dis, 2012; 6(4): 1630.
16. HAYANO J, et al. Pitfalls of Assessment of autonomic function by heart rate variability. Journal of Physiological Anthropology, 2019; 38: 3.
17. JUNQUEIRA-JUNIOR LF. Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease. Rev Soc Bras Med Trop, 2012; 45(2): 243-52.
18. LLAGUNO M, et al. The relationship between heart rate variability and serum cytokines in chronic chagasic patients with persistent parasitemia. Pacing Clin Electrophysiol, 2011; 34: 724-35.
19. MAREK M, at al. Task Force of European Society of cardiology and the North American Society of Pacing and Electrophysiology. Heart Rate Variability: standards of measurement, physiological, interpretation and clinical use. Circulation, 1996; 93: 1043-65.
20. MARIN-NETO JA, et al. Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy – 2023. Arq Bras Cardiol, 2023; 120(6): 20230269.
21. NASCIMENTO BR, et al. Effects of exercise training on heart rate variability in Chagas Heart Disease. Arq Bras cardiol, 2014; 103 (3): 201-208.
22. NASSARIO-JUNIOR O, et al. Assessment of autonomic function by phase rectification of RR-interval histogram analysis in Chagas Disease. Arq Bras Cardiol, 2015; 104(6): 450-456.
23. NIELSEN JC, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Europace, 2020; 22(8): 1147-8.
24. OLIVEIRA MAR, et al. Dysautonomia evaluation by holter in Chagas Heart Disease. Intern J. Cardiovasc Sci, 2022; 35(6): 708-717.
25. OUARHACHE M, et al. Rare pathogenic variants in mitochondrial and inflammation-associated genes may lead to inflammatory cardiomyopathy in Chagas disease. J Clin Immunol, 2021; 41(5): 1048-63.
26. PEDROSA RC. Dysautonomic arrhythmogenesis: a working hypothesis in chronic Chagas cardiomyopathy. Int J cardiovasc Sci, 2020; 33(6): 713-20.
27. PEÑA MM, et al. Disautonomy in different death risk groups (Rassi Score) in patients with Chagas Heart Disease. Pace, 2018; 41(3): 238-245.
28. PÉREZ AR, et al. Immunoneuro endocrine alterations in patients with progressive forms of chronic Chagas disease. J Neuroimmunol, 2011; 235(1-2): 84-90.
29. RABELO DR, et al. Impaired Coronary Flow Reserve in Patients with Indeterminate form of Chagas Disease. Echocardiography, 2014; 31: 67-73.
30. RIBEIRO ALP, et al. Enhanced parasympathetic activity in Chagas disease still stands in need of proof. Int J Cardiol, 2009; 135 (3): 406-408.
31. RODRIGUEZ HO. Histopathological analysis of the pro-arrhythmogenic changes in a suspected Chagas disease sudden death. Heart Res Open J, 2020; 7(1): 11-6.
32. SARMENTO AO, et al. Effects of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas Cardiomyopathy: a randomized controlled trial. Clin Auton Res, 2021; 31: 239-251.
33. SASSI R, et al. Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by Asia Pacific Heart Rhythm Society. Europace, 2015; 17: 1341-1353.
34. SILVA LEV, et al. Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score. Biomed Eng Online, 2022; 21(1): 44.
35. THIERS CA, et al. Autonomic dysfunction and anti-M2 and anti-β1 receptor antibodies in Chagas disease patients. Arq Bras Cardiol, 2012; 99(2): 732-9.
36. TRUCCOLO AB, et al. Associação entre função endotelial e a modulação autonômica em pacientes com Doença de Chagas. Arq Bras Cardiol, 2013; 100(2): 135-140.
37. VASCONCELOS DF e JUNQUEIRA-JUNIOR LF. Distinctive impaired cardiac autonomic modulation of heart rate variability in chronic Chagas' indeterminate and heart diseases. J Electrocardiol, 2009; 42(3): 281-9.
38. VASCONCELOS DF e JUNQUEIRA-JUNIOR LF. Funções autonômica cardíaca e mecânica ventricular na Cardiopatia Chagásica Crônica Assintomática. Arq Bras Cardiol, 2012; 98(2): 111-119.
2. ALENCAR MC, et al. Heart rate recovery in asymptomatic patients with Chagas disease. PLoS One, 2014; 9(6): 100753.
3. BARIZON GC, et al. Relationship between microvascular changes, autonomic denervation, and myocardial fibrosis in Chagas cardiomyopathy: Evaluation by MRI and SPECT imaging. J Nucl Cardiol, 2020; 27(2): 434-44.
4. BELEIGOLI AM, et al. Anthropometric measures and vagal indexes of heart rate variability in a population with high prevalence of Chagas Disease – differences according to obesity status. Intern J Cardiol, 2012; 156(1): 113-115.
5. BELTRAME SP, et al. Impairment of agonist-induced M2 muscarinic receptor activation by autoantibodies from chagasic patients with cardiovascular dysautonomia. Clin Immunol, 2020; 212: 108346.
6. BESTETTI RB, et al. Carlos Chagas discoveries as a drop back to scientific construction of construction of Chronic Chagas Heart Disease. Arq Bras Cardiol, 2016; 107(1): 63-70.
7. CATAI AM, et al. Heart rate variability: are you using properly? Standardization checklist of procedures. Brazilian Journal of Physical Therapy, 2020: 24 (2): 91-102.
8. CHADALAWADA S, et al. Risk of chronic cardiomyopathy among patients with the acute phase or indeterminate form of Chagas disease: a systematic review and meta-analysis. JAMA Netw Open, 2020;3(8): 2015072.
9. CHEVILLARD C, et al. Disease tolerance and pathogen resistance genes may underlie Trypanosoma cruzi persistence and differential progression to Chagas disease cardiomyopathy. Front Immunol, 2018; 9: 2791.
10. DABARIAN AL, et al. Dysregulation of insulin levels in Chagas Heart Disease is associated with altered adipocytokines levels. Can J Physiol Pharmacol, 2019; 97(2): 140-145.
11. DALIRY A, et al. Levels of circulating anti-muscarinic and anti-adrenergic antibodies and their effect on cardiac arrhythmias and dysautonomia in murine models of Chagas disease. Parasitology, 2014; 141(13): 1769-78.
12. FERREIRA JMBB, et al. Chronic Chagasic Cardiopathy in Amazon Region: an etiology to remember. Arq Bras. Cadiol, 2009; 93(6): 93-95.
13. FERREIRA JMBB, et al. Dysregulation of autonomic nervous system in Chagas’ heart disease is associated with altered adipocytokines levels. PLOS One, 2015; 10(7): 131447.
14. FERREIRA, JMBB. Pathophysiology and new targets for therapeutic options in Chagas heart disease. Mem Inst Oswaldo Cruz, 2022;117: 210172.
15. GUEDES PM, et al. Deficient regulatory T cell activity and low frequency of IL-17- producing T cells correlate with the extent of cardiomyopathy in human Chagas' disease. PLoS Negl Trop Dis, 2012; 6(4): 1630.
16. HAYANO J, et al. Pitfalls of Assessment of autonomic function by heart rate variability. Journal of Physiological Anthropology, 2019; 38: 3.
17. JUNQUEIRA-JUNIOR LF. Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease. Rev Soc Bras Med Trop, 2012; 45(2): 243-52.
18. LLAGUNO M, et al. The relationship between heart rate variability and serum cytokines in chronic chagasic patients with persistent parasitemia. Pacing Clin Electrophysiol, 2011; 34: 724-35.
19. MAREK M, at al. Task Force of European Society of cardiology and the North American Society of Pacing and Electrophysiology. Heart Rate Variability: standards of measurement, physiological, interpretation and clinical use. Circulation, 1996; 93: 1043-65.
20. MARIN-NETO JA, et al. Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy – 2023. Arq Bras Cardiol, 2023; 120(6): 20230269.
21. NASCIMENTO BR, et al. Effects of exercise training on heart rate variability in Chagas Heart Disease. Arq Bras cardiol, 2014; 103 (3): 201-208.
22. NASSARIO-JUNIOR O, et al. Assessment of autonomic function by phase rectification of RR-interval histogram analysis in Chagas Disease. Arq Bras Cardiol, 2015; 104(6): 450-456.
23. NIELSEN JC, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Europace, 2020; 22(8): 1147-8.
24. OLIVEIRA MAR, et al. Dysautonomia evaluation by holter in Chagas Heart Disease. Intern J. Cardiovasc Sci, 2022; 35(6): 708-717.
25. OUARHACHE M, et al. Rare pathogenic variants in mitochondrial and inflammation-associated genes may lead to inflammatory cardiomyopathy in Chagas disease. J Clin Immunol, 2021; 41(5): 1048-63.
26. PEDROSA RC. Dysautonomic arrhythmogenesis: a working hypothesis in chronic Chagas cardiomyopathy. Int J cardiovasc Sci, 2020; 33(6): 713-20.
27. PEÑA MM, et al. Disautonomy in different death risk groups (Rassi Score) in patients with Chagas Heart Disease. Pace, 2018; 41(3): 238-245.
28. PÉREZ AR, et al. Immunoneuro endocrine alterations in patients with progressive forms of chronic Chagas disease. J Neuroimmunol, 2011; 235(1-2): 84-90.
29. RABELO DR, et al. Impaired Coronary Flow Reserve in Patients with Indeterminate form of Chagas Disease. Echocardiography, 2014; 31: 67-73.
30. RIBEIRO ALP, et al. Enhanced parasympathetic activity in Chagas disease still stands in need of proof. Int J Cardiol, 2009; 135 (3): 406-408.
31. RODRIGUEZ HO. Histopathological analysis of the pro-arrhythmogenic changes in a suspected Chagas disease sudden death. Heart Res Open J, 2020; 7(1): 11-6.
32. SARMENTO AO, et al. Effects of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas Cardiomyopathy: a randomized controlled trial. Clin Auton Res, 2021; 31: 239-251.
33. SASSI R, et al. Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by Asia Pacific Heart Rhythm Society. Europace, 2015; 17: 1341-1353.
34. SILVA LEV, et al. Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score. Biomed Eng Online, 2022; 21(1): 44.
35. THIERS CA, et al. Autonomic dysfunction and anti-M2 and anti-β1 receptor antibodies in Chagas disease patients. Arq Bras Cardiol, 2012; 99(2): 732-9.
36. TRUCCOLO AB, et al. Associação entre função endotelial e a modulação autonômica em pacientes com Doença de Chagas. Arq Bras Cardiol, 2013; 100(2): 135-140.
37. VASCONCELOS DF e JUNQUEIRA-JUNIOR LF. Distinctive impaired cardiac autonomic modulation of heart rate variability in chronic Chagas' indeterminate and heart diseases. J Electrocardiol, 2009; 42(3): 281-9.
38. VASCONCELOS DF e JUNQUEIRA-JUNIOR LF. Funções autonômica cardíaca e mecânica ventricular na Cardiopatia Chagásica Crônica Assintomática. Arq Bras Cardiol, 2012; 98(2): 111-119.