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      Pacientes chagásicos crônicos portadores de disfunção do nódulo sinusal: a presença de anticorpos IgG com ação agonista muscarínica independe da disfunção ventricular esquerda? Translated title: Chronic Chagas disease patients with sinus node dysfunction: is the presence of IgG antibodies with muscarinic agonist action independent of left ventricular dysfunction?


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          Estudos mostram que anticorpos IgG agonistas muscarínicos, de pacientes chagásicos, alteram a atividade elétrica de células cardíacas in vitro. Outros consideram sua presença, e a da síndrome do nódulo sinusal, conseqüências da lesão cardíaca progressiva. Objetivou-se avaliar a relação entre os anticorpos e as disfunções nodal e ventricular esquerda, em 65 pacientes chagásicos crônicos divididos em grupo I, composto de 31 pacientes portadores da síndrome do nódulo sinusal, e grupo II, de não portadores. A análise dos dados, pelo modelo log linear, mostrou uma interdependência entre a disfunção do nódulo sinusal e os anticorpos (p=0,0021) e entre a disfunção nodal e a ventricular (p=0,0005), mas não houve relação entre esta última e os anticorpos. Idade e sexo não tiveram influência sobre as outras variáveis. Chagásicos crônicos com a síndrome do nódulo sinusal têm maior prevalência de anticorpos agonistas muscarínicos, independentemente da presença de disfunção miocárdica.

          Translated abstract

          Studies have shown that muscarinic agonist IgG antibodies from Chagas disease patients alter the electrical activity of cardiac cells in vitro. Others have considered their presence, along with sinus node dysfunction, to be consequences of progressive cardiac lesions. The aim of this study was to evaluate the relationship between these antibodies and sinus node and left ventricular dysfunction in 65 chronic Chagas disease patients. These patients were divided into group I, composed of 31 patients with sinus node dysfunction, and group II, composed of the patients without this syndrome. Data analysis using the log linear model showed interdependence between sinus node dysfunction and the antibodies (p = 0.0021) and between nodal and ventricular dysfunction (p = 0.0005). However, no relationship was found between the antibodies and ventricular function. Age and sex did not influence any other variables. The chronic Chagas disease patients with sinus node dysfunction had higher prevalence of muscarinic agonist antibodies, independent of the presence of myocardial dysfunction.

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          Most cited references44

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            Four hundred M-mode echocardiographic surveys were distributed to determine interobserver variability in M-mode echocardiographic measurements. This was done with a view toward examining the need and determining the criteria for standardization of measurement. Each survey consisted of five M-mode echocardiograms with a calibration marker, measured by the survey participants anonymously. The echoes were judged of adequate quality for measurement of structures. Seventy-six of the 400 (19%) were returned, allowing comparison of interobserver variability as well as examination of the measurement criteria which were used. Mean measurements and percent uncertainty were derived for each structure for each criterion of measurement. For example, for the aorta, 33% of examiners measured the aorta as an outer/inner or leading edge dimension, and 20% measured it as an outer/outer dimension. The percent uncertainty for the measurement (1.97 SD divided by the mean) showed a mean of 13.8% for the 25 packets of five echoes measured using the former criteria and 24.2% using the latter criteria. For ventricular chamber and cavity measurements, almost one-half of the examiners used the peak of the QRS and one-half of the examiners used the onset of the QRS for determining end-diastole. Estimates of the percent of measurement uncertainty for the septum, posterior wall and left ventricular cavity dimension in this study were 10--25%. They were much higher (40--70%) for the right ventricular cavity and right ventricular anterior wall. The survey shows significant interobserver and interlaboratory variation in measurement when examining the same echoes and indicates a need for ongoing education, quality control and standardization of measurement criteria. Recommendations for new criteria for measurement of M-mode echocardiograms are offered.
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              Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence or absence of asynergy


                Author and article information

                Revista da Sociedade Brasileira de Medicina Tropical
                Rev. Soc. Bras. Med. Trop.
                Sociedade Brasileira de Medicina Tropical - SBMT (Uberaba, MG, Brazil )
                December 2007
                : 40
                : 6
                : 665-671
                [01] Rio de Janeiro RJ orgnameUniversidade Federal do Rio de Janeiro orgdiv1Hospital Universitário Clementino Fraga Filho orgdiv2Serviço de Cardiologia
                [02] Rio de Janeiro RJ orgnameUniversidade Federal do Rio de Janeiro orgdiv1Faculdade de Medicina orgdiv2Hospital Universitário Clementino Fraga Filho
                [03] Rio de Janeiro RJ orgnameUniversidade Federal do Rio de Janeiro orgdiv1Programas de Pesquisa em Engenharia
                [04] Rio de Janeiro RJ orgnameUniversidade Federal do Rio de Janeiro orgdiv1Instituto de Biofísica Carlos Chagas Filho
                S0037-86822007000600014 S0037-8682(07)04000614

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                : 06 November 2007
                : 01 September 2006
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 7

                SciELO Brazil


                Doença de Chagas,Mimetismo molecular,Síndrome do nódulo sinusal,Receptores muscarínicos,Disautonomia,Chagas’ disease,Molecular mimicry,Sinus node dysfunction,Muscarinic receptors,Autonomic dysfunction


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