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Heart rate variability in the prognostic of Chagas Disease

Grant number: 19/21566-9
Support type:Scholarships abroad - Research Internship - Post-doctor
Effective date (Start): June 29, 2020
Effective date (End): June 28, 2021
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal Investigator:José Antonio Marin-Neto
Grantee:Luiz Eduardo Virgilio da Silva
Supervisor abroad: Chung-Kang Peng
Home Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil
Local de pesquisa : Harvard University, Boston, United States  
Associated to the scholarship:18/21212-0 - Prediction of the evolution of Chagas' Disease through heart rate variability, BP.PD

Abstract

One of the major challenges associated with Chagas disease (CD) is the identification of the factors that lead individuals with the indeterminate form of the disease to evolve to the cardiac or digestive forms. Considering there is evidence that dysautonomia is involved in the pathogenetic mechanisms of CD, even in the indeterminate form, we believe that heart rate variability indices, which contain information on the autonomic modulation to the heart, could represent a potential source of information to identify the individuals most likely to develop the clinical forms of CD, in special the chronic cardiomyopathy. In addition, HRV indices could also represent a useful tool for composing a new independent risk-of-death score in patients already suffering the cardiac form of CD. Thus, in the present study, we aim to identify the most relevant HRV indices to characterize the cardiac autonomic impairment that may herald the progression of CD. Two strategies will be adopted: 1) a set of cutting-edge HRV indices will be implemented and evaluated in patients with CD. These indices can be divided into five families of measurements, namely: I) those derived from chaos theory and fractals; II) entropies; III) symbolic dynamics; IV) non-linearity tests; V) dynamics of arrhythmias; 2) new HRV methods will be proposed and implemented, with special focus onto the creation of indices capable of extracting information from arrhythmias, a condition quite prevalent in CD. Two hundred patients chronically infected by T. cruzi are being enrolled from the University Hospital of Ribeirão Preto Medical School, University of São Paulo, with various forms of CD (indeterminate, digestive, cardiomyopathy or mixed). The electrocardiogram will be collected from each patient for 15 minutes and HRV series will be created. Then, HRV indices will be extracted from series and correlated to the clinical information of patients, obtained from exams such as the echocardiogram, 12-lead ECG, chest X-ray and Holter monitoring for 24 hours. (AU)