READERS OPINION
Autonomic dysfunction and beta blocker therapy in Chagas heart disease
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Forlenza, Bernardo dos Santos, Paulo H.F. Bertolucci, Elida B. Ojopi, Wagner F. Gattaz, Daniel Shikanai Kerr" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Giselle" "apellidos" => "Izzo" ] 1 => array:2 [ "nombre" => "Orestes V." "apellidos" => "Forlenza" ] 2 => array:2 [ "nombre" => "Bernardo" "apellidos" => "dos Santos" ] 3 => array:2 [ "nombre" => "Paulo H.F." "apellidos" => "Bertolucci" ] 4 => array:2 [ "nombre" => "Elida B." "apellidos" => "Ojopi" ] 5 => array:2 [ "nombre" => "Wagner F." "apellidos" => "Gattaz" ] 6 => array:2 [ "nombre" => "Daniel Shikanai" "apellidos" => "Kerr" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222021147?idApp=UINPBA00004N" "url" => "/18075932/0000006800000002/v1_202212011614/S1807593222021147/v1_202212011614/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222021123" "issn" => "18075932" "doi" => "10.6061/clinics/2013(02)R01" "estado" => "S300" "fechaPublicacion" => "2013-01-01" "aid" => "2112" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "rev" "cita" => "Clinics. 2013;68:269-74" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">REVIEW</span>" "titulo" => "Muscle residual force enhancement: a brief review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "269" "paginaFinal" => "274" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "cln-68-02-269-g001.jpeg" "Alto" => 527 "Ancho" => 796 "Tamanyo" => 18666 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of muscle residual force enhancement. Both panels show two representative superimposed contractions from the same muscle as it is first activated, stretched to a certain final length, relaxed (solid lines), and then isometrically activated and kept at the same final length before being relaxed again (dashed lines). Top panel: force traces. Bottom panel: length traces. FE: force enhancement. PFE: passive force enhancement.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fábio Carderelli Minozzo, Claudio Andre Barbosa de Lira" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Fábio Carderelli" "apellidos" => "Minozzo" ] 1 => array:2 [ "nombre" => "Claudio Andre Barbosa" "apellidos" => "de Lira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222021123?idApp=UINPBA00004N" "url" => "/18075932/0000006800000002/v1_202212011614/S1807593222021123/v1_202212011614/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">READERS OPINION</span>" "titulo" => "Autonomic dysfunction and beta blocker therapy in Chagas heart disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "275" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Reinaldo B Bestetti, Augusto Cardinalli-Neto" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Reinaldo B" "apellidos" => "Bestetti" "email" => array:1 [ 0 => "rbestetti@netsite.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Augusto" "apellidos" => "Cardinalli-Neto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "UNAERP Medical School, Ribeirão Preto/SP, Brazil" "etiqueta" => "I" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Hospital de Base, São José do Rio Preto/SP, Brazil." "etiqueta" => "II" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Tel.: 55 16 3603-7013" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para10" class="elsevierStylePara elsevierViewall">In a hamster model of Chagas disease, Pimentel et al. (<a class="elsevierStyleCrossRef" href="#bib1">1</a>) recently found that 1) carvedilol decreased mortality in the acute, but not in the chronic stage and 2) in the chronic stage, carvedilol neither changed the left ventricular diameter and/or function, nor attenuated changes in the resting electrocardiogram (ECG), nor decreased the myocardial collagen content.</p><p id="para20" class="elsevierStylePara elsevierViewall">In contrast, we did not observe a decrease in the mortality rate of rats that were infected with <span class="elsevierStyleItalic">Trypanosoma cruzi</span> and then received metoprolol to treat the ensuing acute Chagas disease (<a class="elsevierStyleCrossRef" href="#bib2">2</a>). Conceivably, both the animal model and the <span class="elsevierStyleItalic">T. cruzi</span> strain might account for this disparity. Furthermore, we found that chronic metoprolol administration reversed the ECG abnormalities in the <span class="elsevierStyleItalic">T. cruzi</span>-infected rats at the chronic stage of the disease. Left axis deviations and intraventricular conduction delays have been observed in almost half of rats chronically infected with <span class="elsevierStyleItalic">T. cruzi</span>, which we believe supports the theory that the different animal models used in the two studies were responsible for the different results.</p><p id="para30" class="elsevierStylePara elsevierViewall">Pimentel et al. (<a class="elsevierStyleCrossRef" href="#bib1">1</a>) did not observe any effects of the chronic use of carvedilol on myocardial function and left ventricular remodeling in their hamster model of chronic Chagas heart disease. Although there are no other studies for comparison, we agree with the assertion of Pimentel et al. (<a class="elsevierStyleCrossRef" href="#bib1">1</a>) that intense myocarditis, extensive myocardial fibrosis, and sympathetic denervation may have overshadowed the beneficial effects of the beta blocker therapy in this animal model.</p><p id="para40" class="elsevierStylePara elsevierViewall">Our message is that the absence of a beneficial effect of carvedilol use in a hamster model should not preclude the use of beta blockers in Chagas disease patients, particularly in the following two clinical settings. First, beta blockers may be appropriate for patients with chronic systolic heart failure because the activation of the autonomic nervous system in these patients is similar to that observed in heart failure patients without Chagas disease (<a class="elsevierStyleCrossRef" href="#bib3">3</a>) and because beta blocker therapy has produced good preliminary results in this group of patients (<a class="elsevierStyleCrossRefs" href="#bib4">4-</a>)(<a class="elsevierStyleCrossRef" href="#bib7">7</a>). Second, beta blocker therapy may be suitable for patients receiving implantable cardioverter-defibrillator therapy for the secondary prevention of sudden cardiac death due to the high recurrence rate of malignant arrhythmias in this patient group in the absence of beta blocker therapy (<a class="elsevierStyleCrossRef" href="#bib8">8</a>).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of beta-blockade on myocardial remodeling in Chagas cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ WS Pimentel \n \t\t\t\t\t\t\t\t """ 1 => """ FJA Ramires \n \t\t\t\t\t\t\t\t """ 2 => """ BM Ianni \n \t\t\t\t\t\t\t\t """ 3 => """ VMC Salemi \n \t\t\t\t\t\t\t\t """ 4 => """ AMB Bilate \n \t\t\t\t\t\t\t\t """ 5 => """ E Cunha-Neto \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clinics" "fecha" => "2012" "volumen" => "67" "numero" => "9" "paginaInicial" => "9" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pinto LZ, Soares EG, Muccillo G, Oliveira JSM. Effects of long-term metoprolol administration on the electrocardiogram of rats infected with T. cruzi" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ RB Bestetti \n \t\t\t\t\t\t\t\t """ 1 => """ VN Sales-Neto \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cvr/24.1.7" "Revista" => array:6 [ "tituloSerie" => "Cardiovasc Res" "fecha" => "1990" "volumen" => "24" "numero" => "7" "paginaInicial" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2183936" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral and coronary sinus catecholamine levels in patients with severe congestive heart failure due to Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ RB Bestetti \n \t\t\t\t\t\t\t\t """ 1 => """ J Coutinho-Neto \n \t\t\t\t\t\t\t\t """ 2 => """ L Staibano \n \t\t\t\t\t\t\t\t """ 3 => """ LZ Pinto \n \t\t\t\t\t\t\t\t """ 4 => """ G Muccillo \n \t\t\t\t\t\t\t\t """ 5 => """ JSM Oliveira \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiology" "fecha" => "1995" "volumen" => "86" "numero" => "3" "paginaInicial" => "6" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ FA Botoni \n \t\t\t\t\t\t\t\t """ 1 => """ PA Poole-Wilson \n \t\t\t\t\t\t\t\t """ 2 => """ ALP Ribeiro \n \t\t\t\t\t\t\t\t """ 3 => """ DO Okonko \n \t\t\t\t\t\t\t\t """ 4 => """ BMR Oliveira \n \t\t\t\t\t\t\t\t """ 5 => """ AS Pinto \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Heart J" "fecha" => "2007" "volumen" => "153" "numero" => "4" "paginaInicial" => "8" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of metoprolol in chagasic patients with severe congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ DF Dávila \n \t\t\t\t\t\t\t\t """ 1 => """ F Angel \n \t\t\t\t\t\t\t\t """ 2 => """ GA Bellabarba \n \t\t\t\t\t\t\t\t """ 3 => """ JH Donis \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2002" "volumen" => "85(2-3)" "paginaInicial" => "60" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of B-Blockers on outcome of patients with Chagas'cardiomyopathy with chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ RB Bestetti \n \t\t\t\t\t\t\t\t """ 1 => """ AP Otaviano \n \t\t\t\t\t\t\t\t """ 2 => """ A Cardinalli-Neto \n \t\t\t\t\t\t\t\t """ 3 => """ BF da Rocha \n \t\t\t\t\t\t\t\t """ 4 => """ TA Theodoropoulos \n \t\t\t\t\t\t\t\t """ 5 => """ JA Cordeiro \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2011" "volumen" => "151" "numero" => "2" "paginaInicial" => "8" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beta-blocker therapy and mortality of patients with Chagas cardiomyopathy: a subanalysis of the REMADHE prospective trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ VS Issa \n \t\t\t\t\t\t\t\t """ 1 => """ AF Amaral \n \t\t\t\t\t\t\t\t """ 2 => """ FD Cruz \n \t\t\t\t\t\t\t\t """ 3 => """ SM Ferreira \n \t\t\t\t\t\t\t\t """ 4 => """ GV Guimarães \n \t\t\t\t\t\t\t\t """ 5 => """ PR Chizzola \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2010" "volumen" => "3" "paginaInicial" => "8" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of all-cause mortality for patients with chronic Chagas heart disease receiving implantable cardioverter-defibrillator therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ A Cardinalli-Neto \n \t\t\t\t\t\t\t\t """ 1 => """ RB Bestetti \n \t\t\t\t\t\t\t\t """ 2 => """ JA Cordeiro \n 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