Heart rate variability: Analysis of time-domain indices in patients with chronic Chagas disease before and after an exercise program | Revista Portuguesa de Cardiologia (English edition)

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Cunha, Delma M. Cunha, Daniel A. Kopiler, Bernardo Rangel Tura, Ademir Batista da Cunha" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Marcus Vinicius" "apellidos" => "Amaral da Silva Souza" "email" => array:1 [ 0 => "souza.mv@globo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Carla Cristiane" "apellidos" => "Santos Soares" ] 2 => array:2 [ "nombre" => "Juliana" "apellidos" => "Rega de Oliveira" ] 3 => array:2 [ "nombre" => "Cláudia" "apellidos" => "Rosa de Oliveira" ] 4 => array:2 [ "nombre" => "Paloma" "apellidos" => "Hargreaves Fialho" ] 5 => array:2 [ "nombre" => "Danton M." "apellidos" => "Cunha" ] 6 => array:2 [ "nombre" => "Delma M." "apellidos" => "Cunha" ] 7 => array:2 [ "nombre" => "Daniel A." "apellidos" => "Kopiler" ] 8 => array:2 [ "nombre" => "Bernardo" "apellidos" => "Rangel Tura" ] 9 => array:2 [ "nombre" => "Ademir" "apellidos" => "Batista da Cunha" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Instituto Nacional de Cardiologia, Setor de Reabilitação Cardíaca, Rio de Janeiro, Brazil" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Variabilidade da frequência cardíaca: análise dos índices no domínio do tempo em portadores de cardiopatia chagásica crónica, antes e após um programa de exercícios" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 1611 "Tamanyo" => 69128 ] ] "descripcion" => array:1 [ "en" => "Distribution of pNN50 values pre- and post-rehabilitation for the parasympathetic and sympathetic periods. Post-Para: post-rehabilitation-parasympathetic; Post-Symp: post-rehabilitation-sympathetic; Pre-Para: pre-rehabilitation-parasympathetic; Pre-Symp: pre-rehabilitation-sympathetic." ] ] ] "textoCompleto" => "IntroductionChagas disease (CD) is an infection caused by the kinetoplastid protozoan flagellate Trypanosoma cruzi, and is transmitted by insects of the genera Triatoma, Rhodnius and Panstrongylus. The most common form of transmission is by vectors, but transfusion with infected blood and transmission from mother to fetus are also of epidemiological importance.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>In the 1980s, the disease affected 18–20 million individuals in endemic areas in Latin America. World Health Organization (WHO) data published after a meeting of specialists in Argentina in 2002 indicated that 16–18 million were infected with T. cruzi. However, a 2007 study by Dias estimated the figure at 12–14 million in Latin America, with some infected individuals in Europe and North America.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The acute phase is generally asymptomatic, with an incubation period of a week to a month after the insect bite. A large erythematous swelling (chagoma) can develop at the bite site. Other possible symptoms include fever, swollen lymph glands, appetite loss, hepatosplenomegaly, myocarditis and, more rarely, meningoencephalitis; as the trypanosomes disappear from the bloodstream, peripheral blood testing is negative for the organisms, but anti-Trypanosoma antibodies (IgG) are found in the bloodstream, an indication that CD is moving to the chronic phase.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Patients with chronic Chagas cardiomyopathy (CCC) can remain asymptomatic for 10–20 years, but during this time the parasite continues to reproduce at a low rate, causing irreversible damage to organs including the nervous system and the heart. The consequences are apparent after one or two decades, with gradual onset of dementia, heart disease or digestive tract dilatation, the result of nerve destruction in these organs’ muscle cells. The disease is often fatal at this stage, even with treatment, usually due to heart failure.Reduced heart rate variability (HRV) is a strong risk marker for adverse events in normal individuals and in patients with a wide range of diseases, reflecting the vital role of the autonomic nervous system (ANS) in maintaining health. Reduced HRV is found in hypertension,<a class="elsevierStyleCrossRefs" href="#bib0020">4–6</a> myocardial infarction, coronary disease<a class="elsevierStyleCrossRef" href="#bib0035">7</a> and atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Regular exercise has been shown to increase vagal tone as a result of the physiological adaptations that occur in response to increased cardiac work due to reduced sensitivity of beta receptors. Increased parasympathetic modulation induces electrical stability in the heart, while enhanced sympathetic activity increases the heart's vulnerability and the risk of cardiovascular events.ObjectivesThe objectives of this study were to assess changes in HRV in CD patients after a six-month exercise program and to determine whether the program resulted in reduced SDNN (daytime standard deviation of RR intervals) and increased pNN50 (daytime and nighttime percentage of differences between adjacent RR intervals >50 ms) and rMSSD (the square root of the mean squared differences of successive RR intervals).MethodsWe selected 50 outpatients followed in the CD clinic of the National Institute of Cardiology (INC) and the Evandro Chagas Research Institute (IPEC), who treat patients with positive serology for CD by at least two methods.All patients were informed of the research procedures and gave their written consent. The study was approved by the Research Ethics Committee of INC and IPEC.Patients of both sexes aged between 21 and 75 years, positive serology for CD by ELISA and indirect hemagglutination testing, not being treated with benznidazole, and socioeconomic status allowing travel to the INC three times a week for six months, were included.Patients with pacemakers, those under treatment with stem cells, or with comorbidities preventing participation in the exercise program, including severe hypertension (≥180mmHg systolic and ≥110mmHg diastolic blood pressure), decompensated diabetes, chronic heart failure in NYHA functional class IV, chronic renal failure (serum creatinine >2.0mg/dl), anemia (hemoglobin <10g/100ml or hematocrit <30%), platelet count <120000/mm3, as well as those who were unable to give informed consent or undergo 24-h Holter monitoring and those with joint disease preventing treadmill or cycle ergometer exercise, were excluded.The study was performed in accordance with the Declaration of Helsinki and with CONEP Resolution 196/96.The characteristics of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Patient selectionPatients with positive serology for CCC by indirect hemagglutination testing and ELISA attending INC's outpatient CD clinic were referred to the cardiac rehabilitation unit consecutively and in accordance with the inclusion and exclusion criteria based on their medical history and thorough physical examination.Diagnostic examsLaboratory testsThese included hemogram and blood glucose, creatinine, serum uric acid, total cholesterol, HDL cholesterol, triglycerides, serum potassium, total proteins and protein fractions, BNP, stool analysis for parasites (mainly to exclude schistosomiasis mansoni) and urine analysis.Chest X-rayResting electrocardiogramThe electrocardiograms (ECGs) were analyzed according to the Minnesota code,<a class="elsevierStyleCrossRef" href="#bib0045">9</a> and classified as normal, borderline or abnormal.Cardiopulmonary stress testingTwo-dimensional echocardiography with intracavitary DopplerA conventional technique was used on the equipment available in the Echocardiography Department, with particular attention paid to cross-sections of the longitudinal, subcostal and apical short-axis views of the left ventricle when visualizing the various myocardial segments in order to analyze segmental wall motion.Holter 24-h ambulatory electrocardiographic monitoringThe period of Holter monitoring ranged between 23h 05min and 25h 45min (mean 24h 15min), with patients maintaining their usual activities. A CardioFlash Plus (Cardios) digital system was used, with simultaneous recording of three leads. Recordings were analyzed using CardioManager 5.0 (Cardios) for processing and printing data, which were interpreted by the Arrhythmia Department of INC.HRV was analyzed based on the time-domain indices shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, considering the time between 1 pm and 5 pm as the daytime period of predominantly sympathetic activity, and that between 2 am and 6 am as the nighttime period of predominantly parasympathetic activity.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Exercise programOne-hour exercise sessions were held three times a week, consisting of:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(1)Thirty min of aerobic exercise on an Inbrasport 2000® treadmill, divided into three phases: a 5-min warm-up period with gradually increasing speed; 20min of exercise aiming to reach the patient's training heart rate target zone, taking account of their rating of perceived exertion on the modified Borg scale, in order to maintain moderate to moderate/vigorous effort; and a 5-min slow-down period to a complete stop.</li><li class="elsevierStyleListItem" id="lsti0010">(2)Twenty min of resistance training of the main muscle groups, consisting of two series of 10 repetitions for each of the muscle groups, programmed empirically to achieve 70% of one maximum repetition following a maximum load test to determine what each individual could achieve on one repetition of a particular exercise.</li><li class="elsevierStyleListItem" id="lsti0015">(3)Ten min of flexibility exercises of the main muscle groups.</li></ul>The training heart rate target zone maintains the intensity of aerobic exercise within safe limits, and is determined by cardiopulmonary exercise testing; it is 5–15% above the anaerobic threshold, also known as the lactate threshold or ventilatory threshold, and 10% below the respiratory compensation point.Statistical analysisThis was a before-and-after observational study. The data were presented as means±standard deviation or frequencies and analyzed using a mixed-effects model including a fixed effect per phase and period and a random effect for phase, period and patient. The statistical analysis was performed using R software version 2.12.1 (R Development Core Team, Vienna, Austria). Mixed-effects ANOVA was used for analysis of inference. A difference of five was considered significant, with a standard deviation of 13.8 and thus 23 patients were required to ensure 95% confidence intervals and 60% statistical power.ResultsInitially, 50 patients were invited to undergo 24-h Holter monitoring. Of these, 25 did not attend for the exam, even after several reminders, and were thus excluded, as were a further five who had pacemakers. The remaining 20 underwent the exam; of these, two were excluded due to joint disease that prevented them exercising on a treadmill or cycle ergometer. Thus, 18 patients were selected to participate in the study, 32 being excluded according to the criteria described in the Methods section. The patients were classified in NYHA functional classes II and III.Six patients (33.3%) were black, and 12 (66.7%) were of other ethnicities; mean age was 57.33±9.73 years. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the study population.ECGs and two-dimensional color Doppler echocardiography were performed in 18 patients, but three (16.6%) were lost to the study.Three patients (20%) had normal ECG and eight (53.3%) showed right bundle branch block, which was the most common ECG alteration in our population. Other alterations included non-specific changes in ventricular repolarization, left anterior hemiblock, sinus bradycardia and supraventricular extrasystoles.On echocardiography, 13 patients (86.7%) presented ejection fraction (EF) of over 50% by Simpson's method and only two (13.3%) had EF of less than 50%.Considering the ANS as divided into sympathetic and parasympathetic components in which adrenergic and cholinergic activity are observed, respectively (corresponding to two periods: sympathetic from 1 pm to 5 pm and parasympathetic from 2 am to 6 am), <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the distribution of pNN50 values for the pre- and post-rehabilitation phases for each period. It can be seen that the median did not change significantly between phases, irrespective of the time of day.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> compares pNN50 values in the pre- and post-rehabilitation phases for the two periods, from which it can be seen that mean values of pNN50 remained virtually unchanged, without statistical significance (p>0.05).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the mean and standard error of rMSSD values post-rehabilitation and in the period of sympathetic activity.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a> shows the distribution of rMSSD values in the pre- and post-rehabilitation phases, divided into the sympathetic and parasympathetic periods, from which it can be seen that the median did not change significantly between phases, irrespective of the time of day.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows rMSSD values and standard deviation for the pre- and post-rehabilitation phases and the two periods, from which it can be seen that mean rMSSD values remained virtually unchanged, without statistical significance (p>0.05).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> shows SDNN values post-rehabilitation and in the period of sympathetic activity.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a> shows the distribution of SDNN values in the pre- and post-rehabilitation phases, divided into the sympathetic and parasympathetic periods, from which it can be seen that the median did not change significantly between phases, irrespective of the time of day.<elsevierMultimedia ident="fig0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a> shows SDNN values and standard deviation for the pre- and post-rehabilitation phases and the two periods.<elsevierMultimedia ident="tbl0035"></elsevierMultimedia>DiscussionChagas disease is responsible for a large number of sudden deaths in Latin America, and is a classic example of intrinsic cardiac denervation. It can thus be considered a true experimental model to assess autonomic regulation in humans.Cardiac rehabilitationStudies on physical activity in patients with cardiomyopathy have shown the benefits of regular exercise, such as the 10–30% increase in peak exercise capacity documented by Keteyian et al.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> in patients with chronic heart failure (CHF); Belardinelli et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> showed improvement in quality of life and clinical outcome, while Hornig et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> reported improvement in endothelial function in CHF patients; Hambrecht et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> showed benefits in plasma catecholamine levels, and Piepoli et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> reported reduced morbidity and rehospitalization. All these studies show reductions in the causes of mortality and improvements in cardiac function at rest.Cardiac rehabilitation in chronic Chagas cardiomyopathyThe aim of this study was to assess changes in HRV in patients with CCC after a six-month cardiac rehabilitation program, which can complement medical therapy.The mean age of our study population was 57.3 years, with a predominance of women. The sample thus included older individuals with a higher risk profile; the predominance of women did not effect interpretation of the results.Sousa et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> studied the association between the HRV parameters SDNN, rMSSD and pNN50 and level of physical activity in CD patients and controls. This association was also studied in healthy individuals and CD patients using the International Physical Activity Questionnaire, which assesses levels of physical activity independently of context, and includes employment, leisure and everyday activities. The results showed that levels of normal physical activity correlated significantly with HRV indices in healthy individuals, but not in CD patients, suggesting that these patients’ dysautonomia affects this relationship. A similar result was found in our study, with no significant changes in time-domain indices of HRV during the exercise program.Oliveira and Pedrosa<a class="elsevierStyleCrossRef" href="#bib0080">16</a> analyzed ventilatory response during exercise among CCC patients using the Los Andes clinical and hemodynamic classification. The results indicated that the progressive deterioration in ventilatory response of these patients is more evident when peak functional capacity (VO2) is reduced than when changes are related to the Los Andes classification. Montes de Oca et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> assessed peripheral muscle metabolic and structural characteristics in patients with advanced CD and analyzed whether they correlated with exercise performance; they showed that such patients have decreased oxidative capacity and a shift to anaerobic metabolism in skeletal muscles. They also suggest that muscle abnormalities are related to oxygen delivery, which is probably reduced in part by the abnormal muscle microvasculature. Oliveira et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> compared gas exchange at rest and during exercise in CCC patients and healthy individuals grouped according to the Los Andes classification. The results showed that the functional capacity of patients in the initial phase of CCC (onset of cardiac involvement) is higher than that of patients in an advanced phase and shows a decrease that follows the loss in cardiac-hemodynamic performance. Mady et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> set out to characterize the functional capacity of asymptomatic CD patients with normal left ventricular function, and found that while the patients had normal left ventricular systolic function at rest, their functional capacity was significantly impaired during exercise.In a prospective randomized trial, Lima et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> demonstrated that CD patients who underwent 12 weeks of exercise training showed improved functional capacity and quality of life compared to CD patients in the inactive control group. Although the study did not measure peak oxygen uptake directly, included only a small number of patients and had a short follow-up, it showed increases in exercise tolerance, distance covered on the 6-min walk test and estimated oxygen uptake, as well as improvements in quality of life; it thus represents an advance in research on the management of the cardiomyopathy associated with this important and neglected disease. Lima et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> demonstrated that exercise training is not only effective but feasible and is not associated with significant adverse events. Even in the context of the lack of effect on mortality and improvements in quality of life in the HF-ACTION study, Lima et al.’s study is relevant, bearing in mind the specific mechanisms involved in the pathophysiology of CCC.Our study assessed time-domain indices of HRV through 24-h Holter monitoring before and after a supervised exercise program. Statistical analysis showed that SDNN, pNN50 and rMSSD values did not change significantly (p>0.05), probably due to the large standard deviation observed, poor patient adherence to the program, resulting in a small sample, and the short duration of the program.Heart rate variabilityIt is assumed that neuronal uptake of norepinephrine is impaired in hypertrophic cardiomyopathy due to reduced density of beta receptors, as shown by Ianni and Mady.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>Assessment of HRV has been used to diagnose not only physiological,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> but also psychological disorders. A group of researchers analyzed whether the relationships between self-ratings of anxiety or emotional stress and parasympathetic nervous system components of HRV are independent of personality and cardiorespiratory fitness.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> They found an inverse relationship between perceived emotional stress during a week of exercise training and normalization of the high-frequency (HF) component of HRV (p=0.038), which was independent of age, gender, trait anxiety and cardiorespiratory fitness; they concluded that vagal modulation of heart period appears to be sensitive to the recent experience of persistent emotional stress, regardless of a person's level of physical fitness and disposition toward experiencing anxiety. HRV is normally used in sports medicine to assess cardiac autonomic adaptations to resistance training<a class="elsevierStyleCrossRef" href="#bib0115">23</a> and exercise.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>Differences in HRV between fit and unfit individuals have been thoroughly investigated. Both time-domain and frequency-domain variables are higher in fit than in sedentary individuals, indicating that the former have higher HRV.Ribeiro and Rocha<a class="elsevierStyleCrossRef" href="#bib0125">25</a> assessed rMSSD and very low frequency, low-frequency (LF) and HF indices and found no significant differences at rest between healthy sedentary men and active patients with hypertension and myocardial infarction, suggesting that physical activity influenced autonomic modulation in these patients. Such an effect was also reported by Kropf et al.,<a class="elsevierStyleCrossRef" href="#bib0130">26</a> who analyzed rMSSD at rest in active patients with coronary artery disease and healthy individuals and found no significant differences between the groups. Furthermore, these indices can be used to determine the influence on autonomic regulation of factors such as age,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> gender,<a class="elsevierStyleCrossRef" href="#bib0140">28</a> and exercise.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Heart rate variability and Chagas diseaseSartori et al.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> assessed time- and frequency-domain indices in 81 CCC patients (47 in the indeterminate phase, of whom eight were male, mean age 55.07±10.75 years, and 34 in the chronic phase, of whom eight were male, mean age 57.46±11.59 years) and compared them with a control group of 24 individuals (seven male, mean age 48.50±13.93 years). The variables SDNN, SDNNi and SDANN, rMSSD, pNN50, and LF and HF were measured in all individuals through 24-h Holter monitoring and compared by ANOVA. There were no statistically significant differences between the groups for SDNN, SDNNi or HF (p=0.05), but significant differences were found for SDANN and LF (p=0.01) between controls and both groups of CD patients; patients with CD presented statistically higher values for rMSSD and pNN50 than controls. Spectral analysis showed a reduction in sympathetic response and global impairment of autonomic function as reflected in lower SDANN values in both types of CD patients.de Resende et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> assessed cardiac autonomic function in 84 individuals living in an endemic area through computerized analysis of HRV; the study population consisted of 28 elderly patients with indeterminate CD, 28 elderly individuals without the disease and 28 young adults. There were no statistically significant differences between the groups in terms of systolic and diastolic diameters or left ventricular systolic function, nor in mean RR interval. There was a statistically significant difference in variance, standard deviation, variation coefficient and pNN50 between the young and the elderly, but not between the two elderly groups. The authors concluded that the elderly groups with and without CD did not differ in terms of baseline time-domain indices of cardiac autonomic function.Another important aspect of CD is intrinsic denervation of the ANS, as noted in the first studies on CD in Brazil. Köberle,<a class="elsevierStyleCrossRef" href="#bib0155">31</a> a pioneer in the study of the ANS in CD, adopted the technique of neuron counts in the 1950s, and showed a reduction in the number of parasympathetic nerve cells; he thus considered that Chagas cardiomyopathy involved reduced parasympathetic activity with predominance of the sympathetic.In autopsy studies, Köberle and colleages<a class="elsevierStyleCrossRefs" href="#bib0160">32,33</a> and Mott and Hagstrom<a class="elsevierStyleCrossRef" href="#bib0170">34</a> demonstrated lesions of the cardiac ANS in CD patients and observed that the nerve structures of the heart could be affected in a diffuse or focal manner.In an experimental study, Tafuri and Raso<a class="elsevierStyleCrossRef" href="#bib0175">35</a> demonstrated the damage caused by CD to the sympathetic and parasympathetic nervous system; ganglia lesions could involve all or part of the ganglion, affecting intra- and extra-ganglion nerve fibers.In pharmacological and hemodynamic studies, Amorim et al.<a class="elsevierStyleCrossRef" href="#bib0180">36</a> also suggested that the sympathetic nervous system was impaired in CCC patients, making it clear that further studies are required to assess sympathetic neurons in these patients. In this respect, other diseases that affect the ANS, such as familial amyloid polyneuropathy (FAP), may alter its classic manifestations when patients exercise. FAP is a systemic amyloidosis of autosomal dominant inheritance characterized by ascending neuropathy of motor and sensory fibers and dysautonomia. The condition is associated with reduced ANS nerve fiber density, as reported by Sousa and Saraiva<a class="elsevierStyleCrossRef" href="#bib0185">37</a> These observations mean that wider-ranging studies involving both conditions are necessary, with a prolonged program of supervised exercise training.Cunha et al.<a class="elsevierStyleCrossRef" href="#bib0190">38</a> assessed the role of the ANS in the pathogenesis of CCC. They analyzed 75 patients divided into four groups based on the Los Andes classification (IA, IB, II and III) and measured norepinephrine in 24-h urine in 52 patients with CCC (69%), 12 with other forms of heart disease (in NYHA class IV), the control group, and ten normal individuals. They performed 24-h Holter monitoring in 56 patients (74.6%) to assess HRV, the parameters being analyzed and distributed according to the Los Andes and Lown classifications. Norepinephrine levels were significantly higher (p=0.0001) in the controls (patients with non-Chagas heart disease) than in group III (CCC patients with heart failure). Reduced HRV was observed in CD patients, although this did not correlate with functional class. The authors concluded that norepinephrine levels in CD patients in an advanced stage of cardiac involvement (group III) do not rise as in other forms of heart disease with a similar degree of cardiac involvement, which probably reflects damage to the sympathetic nervous system. HRV was reduced, but one index of the parasympathetic system (daytime and nighttime rMSSD) was elevated in a group of patients with complex arrhythmias.ConclusionThe HRV parameters SDNN, rMSSD and pNN50 in our patients with CCC did not undergo statistically significant changes after a six-month cardiac rehabilitation program.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:19 [ 0 => array:2 [ "identificador" => "xres177680" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec166333" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres177679" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec166332" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objectives" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Methods" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Patient selection" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0025" "titulo" => "Diagnostic exams" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Laboratory tests" ] ] ] 1 => array:3 [ "identificador" => "sec0035" "titulo" => "Chest X-ray" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Resting electrocardiogram" ] ] ] 2 => array:3 [ "identificador" => "sec0045" "titulo" => "Cardiopulmonary stress testing" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Two-dimensional echocardiography with intracavitary Doppler" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Holter 24-h ambulatory electrocardiographic monitoring" ] ] ] ] ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Exercise program" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Statistical analysis" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Results" ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 12 => array:2 [ "identificador" => "sec0080" "titulo" => "Cardiac rehabilitation" ] 13 => array:2 [ "identificador" => "sec0085" "titulo" => "Cardiac rehabilitation in chronic Chagas cardiomyopathy" ] 14 => array:2 [ "identificador" => "sec0090" "titulo" => "Heart rate variability" ] 15 => array:2 [ "identificador" => "sec0095" "titulo" => "Heart rate variability and Chagas disease" ] 16 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusion" ] 17 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflicts of interest" ] 18 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-07-28" "fechaAceptado" => "2012-10-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec166333" "palabras" => array:3 [ 0 => "Chagas disease" 1 => "Cardiac rehabilitation" 2 => "Heart rate variability" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec166332" "palabras" => array:3 [ 0 => "Doença de Chagas" 1 => "Reabilitação cardíaca" 2 => "Variabilidade da frequência cardíaca" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Chagas disease (CD) is an infection caused by the protozoan flagellate Trypanosoma cruzi, and transmitted by insects of the genera Triatoma, Rhodnius and Panstrongylus. The heart is affected to varying degrees by inflammatory and destructive lesions in atrial and ventricular myocardial fibers. Several studies have demonstrated the benefits of exercise in patients with congestive heart failure (CHF), including reduced sympathetic tone and increased parasympathetic tone, the result of reduced epinephrine and norepinephrine levels, both at rest and during exercise, including at submaximal levels. It has been hypothesized that the increase in sympathetic arousal during exercise improves peripheral muscle metabolism. ObjectivesThe objectives of this study were to select patients with chronic Chagas cardiomyopathy (CCC) with dysautonomia on 24-h Holter monitoring, assess autonomic function after rehabilitation, and determine whether it resulted in reduced daytime levels of SDNN and increased daytime and nighttime levels of pNN50 and rMSSD. MethodsWe analyzed time-domain indices of heart rate variability through 24-h Holter monitoring before and after a supervised exercise program. We studied 18 CCC patients (five men), mean age 57.33±9.73 years, followed at the CD outpatient clinic of the National Institute of Cardiology and IPEC/Fiocruz in Rio de Janeiro, Brazil, between April 2009 and November 2010. The following tests were used to assess the severity of CCC: clinical examination, functional evaluation by cardiopulmonary stress testing, electrocardiogram and conventional Doppler echocardiography. The exams were performed within a month of the start and end of the exercise program, which consisted of 60-min sessions of aerobic exercise on a treadmill and resistance training three times a week for six months. The goal was to reach the patients’ heart rate target zone during training, and their rating of perceived exertion was assessed by the modified Borg scale. ResultsThere were no statistically significant differences (p>0.05) in SDNN, pNN50 and rMSSD, probably due to the large standard deviation observed, patients’ poor adherence to the program and their low socioeconomic status, resulting in a small sample, and the short duration of the program. ConclusionHeart rate variability parameters in patients with CCC did not undergo statistically significant changes after a six-month cardiac rehabilitation program." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "A doença de Chagas (DC) é uma infeção causada pelo flagelado Trypanosoma cruzi, transmitida por insetos do género Triatoma.Estudos têm demonstrado o resultado benéfico da prática de exercícios em portadores de insuficiência cardíaca (IC), o seu efeito de redução do tónus simpático e o aumento do tónus parassimpático relacionado com a redução dos níveis de epinefrina e noraepinefrina. Este estudo teve como objetivos: detetar pacientes com cardiopatia chagásica crónica (CCC) com disautonomia através do Holter 24h, a função autonómica após reabilitação, a redução dos níveis de SDNN/d e um aumento dos níveis de pNN50/d e pNN50/noite, bem como de rMSSD/d e noite. Foi feita uma intervenção tipo antes e depois com avaliação dos índices de domínios do tempo da variabilidade da frequência cardíaca (VFC) antes e ao final do programa de exercícios. Foram estudados 18 pacientes, sendo cinco homens, com CCC e idade média de 57,33±9,73 anos, no ambulatório de DC do Instituto Nacional de Cardiologia (INC) entre abril de 2009 e novembro de 2010. Os exercícios foram: atividade aeróbica em esteira rolante e exercícios contrarresistidos com duração de 60min e frequência de três vezes por semana. Os valores de SDNN, pNN50 e rMSSD avaliados mostram-se quase inalterados sem significância estatística (p>0,05). Concluímos que os valores dos parâmetros de VFC em portadores de CCC não se alteraram antes e após a intervenção com um programa de reabilitação cardíaca de seis meses." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Amaral da Silva Souza MV, et al. Variabilidade da frequência cardíaca: análise dos índices no domínio do tempo em portadores de cardiopatia chagásica crónica, antes e após um programa de exercícios. Rev Port Cardiol. 2013. http://dx.doi.org/10.1016/j.repc.2012.12.004." ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 1611 "Tamanyo" => 69128 ] ] "descripcion" => array:1 [ "en" => "Distribution of pNN50 values pre- and post-rehabilitation for the parasympathetic and sympathetic periods. Post-Para: post-rehabilitation-parasympathetic; Post-Symp: post-rehabilitation-sympathetic; Pre-Para: pre-rehabilitation-parasympathetic; Pre-Symp: pre-rehabilitation-sympathetic." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1458 "Ancho" => 1632 "Tamanyo" => 68168 ] ] "descripcion" => array:1 [ "en" => "Distribution of rMSSD values pre- and post-rehabilitation for the parasympathetic and sympathetic periods. Post-Para: post-rehabilitation-parasympathetic; Post-Symp: post-rehabilitation-sympathetic; Pre-Para: pre-rehabilitation-parasympathetic; Pre-Symp: pre-rehabilitation-sympathetic." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1465 "Ancho" => 1625 "Tamanyo" => 70417 ] ] "descripcion" => array:1 [ "en" => "Distribution of SDNN values pre- and post-rehabilitation for the parasympathetic and sympathetic periods. Post-Para: post-rehabilitation-parasympathetic; Post-Symp: post-rehabilitation-sympathetic; Pre-Para: pre-rehabilitation-parasympathetic; Pre-Symp: pre-rehabilitation-sympathetic." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "F: female; M: male." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender (M/F) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.3±9.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">159.4±9.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Body mass index (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7±4.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272112.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the study population." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Unit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Definition \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean RR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean of RR intervals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SDNN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Standard deviation of RR intervals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SDNNi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean of the standard deviation of all RR intervals for all 5-min segments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SDANN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Standard deviation of average RR intervals calculated for 5-min segments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">rMSSD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Square root of the mean squared differences of successive RR intervals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pNN50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of differences between adjacent RR intervals >50ms \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272111.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Definition of time-domain indices of heart rate variability." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Para.: parasympathetic; Post: post-rehabilitation; Pre: pre-rehabilitation; Symp.: sympathetic." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Phase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Para. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.1±22.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Para. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.0±20.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.4±21.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.8±18.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272115.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mean pre- and post-rehabilitation pNN50 values and standard deviation for the daytime and nighttime periods." ] ] 6 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Post-rehab: post-rehabilitation; SE: standard error; Symp.: period of sympathetic activity." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">rMSSD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Estimated value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">SE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">t \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-rehab. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.171733 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.003312 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3170683 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.07513279 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−9.964565 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.838052 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.4572228 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.1457007 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272109.png" ] ] ] ] "descripcion" => array:1 [ "en" => "rMSSD values post-rehabilitation and in the period of sympathetic activity." ] ] 7 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Para.: parasympathetic; Post: post-rehabilitation; Pre: pre-rehabilitation; Symp.: sympathetic." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Phase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Para. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.2±69.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Para. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.5±92.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.7±66.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.1±71 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272114.png" ] ] ] ] "descripcion" => array:1 [ "en" => "rMSSD values and standard deviation for the pre- and post-rehabilitation phases and the two periods." ] ] 8 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Post-rehab.: post-rehabilitation; SE: standard error; Symp.: period of sympathetic activity." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">SDNN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Estimated value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">SE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">t \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-rehab. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.782242 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.505607 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.4276683 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6690821 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.717601 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.049713 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9179912 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3590788 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272113.png" ] ] ] ] "descripcion" => array:1 [ "en" => "SDNN values post-rehabilitation and in the period of sympathetic activity." ] ] 9 => array:7 [ "identificador" => "tbl0035" "etiqueta" => "Table 7" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Para.: parasympathetic; Post: post-rehabilitation; Pre: pre-rehabilitation; Symp.: sympathetic." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Phase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean±standard deviation \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Para. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.4±46.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Para. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.8±51.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.5±42.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.2±48.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272110.png" ] ] ] ] "descripcion" => array:1 [ "en" => "SDNN values and standard deviation for the pre- and post-rehabilitation phases and the two periods." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiologia e controle da transmissão vetorial da doença de Chagas no Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C. Silveira" 1 => "D.F. Rezende" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Soc Bras Med Trop" "fecha" => "1994" "volumen" => "27" "numero" => "Suppl. III" "paginaInicial" => "11" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8008914" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Globalização, iniqüidade e doença de Chagas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.C. Dias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Cad Saude Publica" "fecha" => "2007" "volumen" => "23" "numero" => "Suppl. 1" "paginaInicial" => "S13" "paginaFinal" => "S22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17308713" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of Chagas disease in the Latin American immigrant population in a primary health centre in Barcelona (Spain)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Soriano Arantes" 1 => "J. Muñoz Gutierrez" 2 => "M. Vergés Navarro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.actatropica.2009.07.014" "Revista" => array:6 [ "tituloSerie" => "Acta Trop" "fecha" => "2009" "volumen" => "112" "paginaInicial" => "228" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19631185" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análise da variabilidade da frequência cardíaca em pacientes hipertensos, antes e depois do tratamento com inibidores da enzima conversora da angiotensina II" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Menezes Jr" 1 => "H.G. Moreira" 2 => "M.T. Daher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2004" "volumen" => "83" "paginaInicial" => "165" "paginaFinal" => "168" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of impaired heart rate variability and clinical outcome in patients with acute myocardial infarction treated by primary angioplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Larosa" 1 => "G.A. Sgueglia" 2 => "A. Sestito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cardiovasc Med (Hagerstown)" "fecha" => "2008" "volumen" => "9" "paginaInicial" => "76" "paginaFinal" => "80" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlates of the shift in heart rate variability with an active postural change in a healthy population sample: the Atherosclerosis Risk in Communities study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Carnethon" 1 => "D. Liao" 2 => "G.W. Evans" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2002" "volumen" => "143" "paginaInicial" => "808" "paginaFinal" => "813" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12040341" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Attenuation of autonomic nervous system functions in hypertensive patients at rest and during orthostatic stimulation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Karas" 1 => "P. Larochelle" 2 => "R.A. LeBlanc" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Hypertens (Greenwich)" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "97" "paginaFinal" => "104" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart rate variability, trait anxiety, and perceived stress among physically fit men and women" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.K. Dishman" 1 => "Y. Nakamura" 2 => "M.E. Garcia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Psychophysiol" "fecha" => "2000" "volumen" => "37" "paginaInicial" => "121" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10831999" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular survey methods" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.B. Rose" 1 => "H. Blackburn" 2 => "R.F. Gillium" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "World Health Organization, monograph series, 56" "fecha" => "1982" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise training in patients with heart failure. A randomized, controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.J. Keteyian" 1 => "A.B. Levine" 2 => "C.A. Brawner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1996" "volumen" => "124" "paginaInicial" => "1051" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8633818" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Belardinelli" 1 => "D. Georgiou" 2 => "G. Cianci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1999" "volumen" => "99" "paginaInicial" => "1173" "paginaFinal" => "1182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10069785" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical training improves endothelial function in patients with chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Hornig" 1 => "V. Maier" 2 => "H. Drexler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1996" "volumen" => "93" "paginaInicial" => "210" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8548890" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Hambrecht" 1 => "S. Gielen" 2 => "A. Linke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2000" "volumen" => "283" "paginaInicial" => "3095" "paginaFinal" => "3101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10865304" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ExTraMATCH Collaborative" "etal" => true "autores" => array:3 [ 0 => "M.F. Piepoli" 1 => "C. Davos" 2 => "D.P. Francis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.37938.645220.EE" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2004" "volumen" => "328" "paginaInicial" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14729656" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Six-minute walk test in Chagas cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Sousa" 1 => "F.A. Botoni" 2 => "R.R. Britto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2007.01.034" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2008" "volumen" => "125" "paginaInicial" => "139" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17399822" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilatory response during exercise among chronic Chagas cardiopathy patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.P. Oliveira" 1 => "R.C. Pedrosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sao Paulo Med J" "fecha" => "2006" "volumen" => "124" "paginaInicial" => "280" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17262161" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise performance and skeletal muscles in patients with advanced Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Montes de Oca" 1 => "S.H. Torres" 2 => "J.G. Loyo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "125" "paginaInicial" => "1306" "paginaFinal" => "1314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15078739" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gas exchange during exercise in different evolutional stages of chronic Chagas’ heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.P. Oliveira" 1 => "R.C. Pedrosa" 2 => "A. Giannella-Neto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2000" "volumen" => "75" "paginaInicial" => "481" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11175473" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maximal functional capacity in patients with Chagas’ cardiomyopathy without congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Mady" 1 => "B.M. Ianni" 2 => "E. Arteaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1054/jcaf.2000.8828" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2000" "volumen" => "6" "paginaInicial" => "220" "paginaFinal" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10997748" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized trial of the effects of exercise training in Chagas cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.M. Lima" 1 => "M.O. Rocha" 2 => "M.C. Nunes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfq123" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2010" "volumen" => "12" "paginaInicial" => "866" "paginaFinal" => "873" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20675669" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The indeterminate form of Chagas’disease. Myths vs facts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.M. Ianni" 1 => "C. Mady" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "1997" "volumen" => "68" "paginaInicial" => "147" "paginaFinal" => "148" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9435350" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Redução da variabilidade da freqüência cardíaca em indivíduos de meia-idade e o efeito do treinamento de força" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.L. Lopes" 1 => "F.M. Pereira" 2 => "M.M. Reboredo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Bras Fisioter" "fecha" => "2007" "volumen" => "11" "paginaInicial" => "113" "paginaFinal" => "119" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autonomic modulation of heart rate of young and postmenopausal women undergoing estrogen therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.F. Neves" 1 => "M.F. Silva de Sá" 2 => "L. Gallo Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Braz J Med Biol Res" "fecha" => "2007" "volumen" => "40" "paginaInicial" => "491" "paginaFinal" => "499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17401492" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progressive chronic Chagas heart disease ten years after treatment with anti-Trypanosoma cruzi nitroderivatives" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Lauria-Pires" 1 => "M.S. Braga" 2 => "A.C. Vexenat" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Trop Med Hyg" "fecha" => "2000" "volumen" => "63" "paginaInicial" => "111" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11388500" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Indeterminate form of Chagas’ disease: considerations about diagnosis and prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.L. Ribeiro" 1 => "Rocha MO" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Soc Bras Med Trop" "fecha" => "1998" "volumen" => "31" "paginaInicial" => "301" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9612022" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Doença de Chagas: a construção de um fato científico e de um problema de saúde pública no Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.P. Kropf" 1 => "N. Azevedo" 2 => "L.O. Ferreira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ciênc Saúde Coletiva" "fecha" => "2000" "volumen" => "5" "paginaInicial" => "347" "paginaFinal" => "365" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variabilidade da freqüência cardíaca em pacientes com doença de Chagas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Menezes Jr." 1 => "C.F.M. Queiroz" 2 => "F.P. Carzola" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Reblampa" "fecha" => "2000" "volumen" => "13" "paginaInicial" => "139" "paginaFinal" => "142" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análise temporal da variabilidade da freqüência cardíaca no estado basal em idosos chagásicos na forma indeterminada em área endêmica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.A. de Resende" 1 => "A.C. Carneiro" 2 => "B.D. Ferreira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Soc Bras Med Trop" "fecha" => "2003" "volumen" => "36" "paginaInicial" => "703" "paginaFinal" => "706" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15049110" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe myocarditis and esophagitis, during reversible long standing Chagas’ disease recrudescence in immunocompromised host" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.V. Simões" 1 => "F.A. Soares" 2 => "J.A. Marin-Neto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "1995" "volumen" => "49" "paginaInicial" => "271" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7649674" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Follow-up of 18 patients with human immunodeficiency virus infection and chronic Chagas’ disease, with reactivation of Chagas’ disease causing cardiac disease in three patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.M. Sartori" 1 => "M.A. Shikanai-Yasuda" 2 => "V. Amato Neto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "1998" "volumen" => "26" "paginaInicial" => "177" "paginaFinal" => "179" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9455528" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiopathia parasympathicopriva" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Köberle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Münch Med Wochenschrift" "fecha" => "1959" "volumen" => "101" "paginaInicial" => "1308" "paginaFinal" => "1310" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enteromegaly and cardiomegaly in Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Köberle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "1963" "volumen" => "4" "paginaInicial" => "399" "paginaFinal" => "405" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14084752" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patologia da moléstia de Chagas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Köberle" 1 => "R.B. Costa" 2 => "J.S. Oliveira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med" "fecha" => "1972" "volumen" => "5" "paginaInicial" => "5" "paginaFinal" => "45" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pathologic lesions of the cardiac autonomic nervous system in chronic chagas’ myocarditis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.E. Mott" 1 => "J.W. Hagstrom" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1965" "volumen" => "31" "paginaInicial" => "273" "paginaFinal" => "286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14261745" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lesões do sistema nervoso autônomo do camundongo albino na tripanosomíase" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.L. Tafuri" 1 => "P. Raso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "O Hospital" "fecha" => "1962" "volumen" => "62" "paginaInicial" => "1324" "paginaFinal" => "1342" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of acute elevation in blood pressure and of atropine on heart rate in Chagas’ disease. A preliminary report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.S. Amorim" 1 => "R.A. Godoy" 2 => "J.C. Manço" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1968" "volumen" => "38" "paginaInicial" => "289" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4969957" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurodegeneration in familial amyloid polyneuropathy: from pathology to molecular signaling" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.M. Sousa" 1 => "M.J. Saraiva" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Prog Neurobiol" "fecha" => "2003" "volumen" => "71" "paginaInicial" => "385" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14757117" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Norepinephrine and heart rate variability: a marker of dysautonomia in chronic Chagas cardiopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.B. Cunha" 1 => "D.M. Cunha" 2 => "R.C. Pedrosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "29" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12712809" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000003/v1_201305171232/S2174204913000548/v1_201305171232/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000003/v1_201305171232/S2174204913000548/v1_201305171232/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000548?idApp=UINPBA00004E"]

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Heart rate variability: Analysis of time-domain indices in patients with chronic Chagas disease before and after an exercise program

Variabilidade da frequência cardíaca: análise dos índices no domínio do tempo em portadores de cardiopatia chagásica crónica, antes e após um programa de exercícios

Marcus Vinicius Amaral da Silva Souza

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souza.mv@globo.com

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, Carla Cristiane Santos Soares, Juliana Rega de Oliveira, Cláudia Rosa de Oliveira, Paloma Hargreaves Fialho, Danton M. Cunha, Delma M. Cunha, Daniel A. Kopiler, Bernardo Rangel Tura, Ademir Batista da Cunha

Instituto Nacional de Cardiologia, Setor de Reabilitação Cardíaca, Rio de Janeiro, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chagas disease &#40;CD&#41; is an infection caused by the kinetoplastid protozoan flagellate <span class="elsevierStyleItalic">Trypanosoma cruzi</span>&#44; and is transmitted by insects of the genera <span class="elsevierStyleItalic">Triatoma</span>&#44; <span class="elsevierStyleItalic">Rhodnius</span> and <span class="elsevierStyleItalic">Panstrongylus</span>&#46; The most common form of transmission is by vectors&#44; but transfusion with infected blood and transmission from mother to fetus are also of epidemiological importance&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the 1980s&#44; the disease affected 18&#8211;20 million individuals in endemic areas in Latin America&#46; World Health Organization &#40;WHO&#41; data published after a meeting of specialists in Argentina in 2002 indicated that 16&#8211;18 million were infected with <span class="elsevierStyleItalic">T&#46; cruzi</span>&#46; However&#44; a 2007 study by Dias estimated the figure at 12&#8211;14 million in Latin America&#44; with some infected individuals in Europe and North America&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The acute phase is generally asymptomatic&#44; with an incubation period of a week to a month after the insect bite&#46; A large erythematous swelling &#40;chagoma&#41; can develop at the bite site&#46; Other possible symptoms include fever&#44; swollen lymph glands&#44; appetite loss&#44; hepatosplenomegaly&#44; myocarditis and&#44; more rarely&#44; meningoencephalitis&#59; as the trypanosomes disappear from the bloodstream&#44; peripheral blood testing is negative for the organisms&#44; but anti-Trypanosoma antibodies &#40;IgG&#41; are found in the bloodstream&#44; an indication that CD is moving to the chronic phase&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients with chronic Chagas cardiomyopathy &#40;CCC&#41; can remain asymptomatic for 10&#8211;20 years&#44; but during this time the parasite continues to reproduce at a low rate&#44; causing irreversible damage to organs including the nervous system and the heart&#46; The consequences are apparent after one or two decades&#44; with gradual onset of dementia&#44; heart disease or digestive tract dilatation&#44; the result of nerve destruction in these organs&#8217; muscle cells&#46; The disease is often fatal at this stage&#44; even with treatment&#44; usually due to heart failure&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Reduced heart rate variability &#40;HRV&#41; is a strong risk marker for adverse events in normal individuals and in patients with a wide range of diseases&#44; reflecting the vital role of the autonomic nervous system &#40;ANS&#41; in maintaining health&#46; Reduced HRV is found in hypertension&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> myocardial infarction&#44; coronary disease<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Regular exercise has been shown to increase vagal tone as a result of the physiological adaptations that occur in response to increased cardiac work due to reduced sensitivity of beta receptors&#46; Increased parasympathetic modulation induces electrical stability in the heart&#44; while enhanced sympathetic activity increases the heart&#39;s vulnerability and the risk of cardiovascular events&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Objectives</span><p id="par0030" class="elsevierStylePara elsevierViewall">The objectives of this study were to assess changes in HRV in CD patients after a six-month exercise program and to determine whether the program resulted in reduced SDNN &#40;daytime standard deviation of RR intervals&#41; and increased pNN50 &#40;daytime and nighttime percentage of differences between adjacent RR intervals &#62;50 ms&#41; and rMSSD &#40;the square root of the mean squared differences of successive RR intervals&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We selected 50 outpatients followed in the CD clinic of the National Institute of Cardiology &#40;INC&#41; and the Evandro Chagas Research Institute &#40;IPEC&#41;&#44; who treat patients with positive serology for CD by at least two methods&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients were informed of the research procedures and gave their written consent&#46; The study was approved by the Research Ethics Committee of INC and IPEC&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients of both sexes aged between 21 and 75 years&#44; positive serology for CD by ELISA and indirect hemagglutination testing&#44; not being treated with benznidazole&#44; and socioeconomic status allowing travel to the INC three times a week for six months&#44; were included&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patients with pacemakers&#44; those under treatment with stem cells&#44; or with comorbidities preventing participation in the exercise program&#44; including severe hypertension &#40;&#8805;180<span class="elsevierStyleHsp" style=""></span>mmHg systolic and &#8805;110<span class="elsevierStyleHsp" style=""></span>mmHg diastolic blood pressure&#41;&#44; decompensated diabetes&#44; chronic heart failure in NYHA functional class IV&#44; chronic renal failure &#40;serum creatinine &#62;2&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; anemia &#40;hemoglobin &#60;10<span class="elsevierStyleHsp" style=""></span>g&#47;100<span class="elsevierStyleHsp" style=""></span>ml or hematocrit &#60;30&#37;&#41;&#44; platelet count &#60;120<span class="elsevierStyleHsp" style=""></span>000&#47;mm<span class="elsevierStyleSup">3</span>&#44; as well as those who were unable to give informed consent or undergo 24-h Holter monitoring and those with joint disease preventing treadmill or cycle ergometer exercise&#44; were excluded&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study was performed in accordance with the Declaration of Helsinki and with CONEP Resolution 196&#47;96&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The characteristics of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient selection</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients with positive serology for CCC by indirect hemagglutination testing and ELISA attending INC&#39;s outpatient CD clinic were referred to the cardiac rehabilitation unit consecutively and in accordance with the inclusion and exclusion criteria based on their medical history and thorough physical examination&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnostic exams</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Laboratory tests</span><p id="par0070" class="elsevierStylePara elsevierViewall">These included hemogram and blood glucose&#44; creatinine&#44; serum uric acid&#44; total cholesterol&#44; HDL cholesterol&#44; triglycerides&#44; serum potassium&#44; total proteins and protein fractions&#44; BNP&#44; stool analysis for parasites &#40;mainly to exclude schistosomiasis mansoni&#41; and urine analysis&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Chest X-ray</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resting electrocardiogram</span><p id="par0075" class="elsevierStylePara elsevierViewall">The electrocardiograms &#40;ECGs&#41; were analyzed according to the Minnesota code&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and classified as normal&#44; borderline or abnormal&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cardiopulmonary stress testing</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Two-dimensional echocardiography with intracavitary Doppler</span><p id="par0080" class="elsevierStylePara elsevierViewall">A conventional technique was used on the equipment available in the Echocardiography Department&#44; with particular attention paid to cross-sections of the longitudinal&#44; subcostal and apical short-axis views of the left ventricle when visualizing the various myocardial segments in order to analyze segmental wall motion&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Holter 24-h ambulatory electrocardiographic monitoring</span><p id="par0085" class="elsevierStylePara elsevierViewall">The period of Holter monitoring ranged between 23<span class="elsevierStyleHsp" style=""></span>h 05<span class="elsevierStyleHsp" style=""></span>min and 25<span class="elsevierStyleHsp" style=""></span>h 45<span class="elsevierStyleHsp" style=""></span>min &#40;mean 24<span class="elsevierStyleHsp" style=""></span>h 15<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; with patients maintaining their usual activities&#46; A CardioFlash Plus &#40;Cardios&#41; digital system was used&#44; with simultaneous recording of three leads&#46; Recordings were analyzed using CardioManager 5&#46;0 &#40;Cardios&#41; for processing and printing data&#44; which were interpreted by the Arrhythmia Department of INC&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">HRV was analyzed based on the time-domain indices shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; considering the time between 1 pm and 5 pm as the daytime period of predominantly sympathetic activity&#44; and that between 2 am and 6 am as the nighttime period of predominantly parasympathetic activity&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Exercise program</span><p id="par0095" class="elsevierStylePara elsevierViewall">One-hour exercise sessions were held three times a week&#44; consisting of&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Thirty min of aerobic exercise on an Inbrasport 2000<span class="elsevierStyleSup">&#174;</span> treadmill&#44; divided into three phases&#58; a 5-min warm-up period with gradually increasing speed&#59; 20<span class="elsevierStyleHsp" style=""></span>min of exercise aiming to reach the patient&#39;s training heart rate target zone&#44; taking account of their rating of perceived exertion on the modified Borg scale&#44; in order to maintain moderate to moderate&#47;vigorous effort&#59; and a 5-min slow-down period to a complete stop&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Twenty min of resistance training of the main muscle groups&#44; consisting of two series of 10 repetitions for each of the muscle groups&#44; programmed empirically to achieve 70&#37; of one maximum repetition following a maximum load test to determine what each individual could achieve on one repetition of a particular exercise&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ten min of flexibility exercises of the main muscle groups&#46;</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">The training heart rate target zone maintains the intensity of aerobic exercise within safe limits&#44; and is determined by cardiopulmonary exercise testing&#59; it is 5&#8211;15&#37; above the anaerobic threshold&#44; also known as the lactate threshold or ventilatory threshold&#44; and 10&#37; below the respiratory compensation point&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0120" class="elsevierStylePara elsevierViewall">This was a before-and-after observational study&#46; The data were presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or frequencies and analyzed using a mixed-effects model including a fixed effect per phase and period and a random effect for phase&#44; period and patient&#46; The statistical analysis was performed using R software version 2&#46;12&#46;1 &#40;R Development Core Team&#44; Vienna&#44; Austria&#41;&#46; Mixed-effects ANOVA was used for analysis of inference&#46; A difference of five was considered significant&#44; with a standard deviation of 13&#46;8 and thus 23 patients were required to ensure 95&#37; confidence intervals and 60&#37; statistical power&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0125" class="elsevierStylePara elsevierViewall">Initially&#44; 50 patients were invited to undergo 24-h Holter monitoring&#46; Of these&#44; 25 did not attend for the exam&#44; even after several reminders&#44; and were thus excluded&#44; as were a further five who had pacemakers&#46; The remaining 20 underwent the exam&#59; of these&#44; two were excluded due to joint disease that prevented them exercising on a treadmill or cycle ergometer&#46; Thus&#44; 18 patients were selected to participate in the study&#44; 32 being excluded according to the criteria described in the <span class="elsevierStyleItalic">Methods</span> section&#46; The patients were classified in NYHA functional classes II and III&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Six patients &#40;33&#46;3&#37;&#41; were black&#44; and 12 &#40;66&#46;7&#37;&#41; were of other ethnicities&#59; mean age was 57&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;73 years&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the study population&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">ECGs and two-dimensional color Doppler echocardiography were performed in 18 patients&#44; but three &#40;16&#46;6&#37;&#41; were lost to the study&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Three patients &#40;20&#37;&#41; had normal ECG and eight &#40;53&#46;3&#37;&#41; showed right bundle branch block&#44; which was the most common ECG alteration in our population&#46; Other alterations included non-specific changes in ventricular repolarization&#44; left anterior hemiblock&#44; sinus bradycardia and supraventricular extrasystoles&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">On echocardiography&#44; 13 patients &#40;86&#46;7&#37;&#41; presented ejection fraction &#40;EF&#41; of over 50&#37; by Simpson&#39;s method and only two &#40;13&#46;3&#37;&#41; had EF of less than 50&#37;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Considering the ANS as divided into sympathetic and parasympathetic components in which adrenergic and cholinergic activity are observed&#44; respectively &#40;corresponding to two periods&#58; sympathetic from 1 pm to 5 pm and parasympathetic from 2 am to 6 am&#41;&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the distribution of pNN50 values for the pre- and post-rehabilitation phases for each period&#46; It can be seen that the median did not change significantly between phases&#44; irrespective of the time of day&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> compares pNN50 values in the pre- and post-rehabilitation phases for the two periods&#44; from which it can be seen that mean values of pNN50 remained virtually unchanged&#44; without statistical significance &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the mean and standard error of rMSSD values post-rehabilitation and in the period of sympathetic activity&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a> shows the distribution of rMSSD values in the pre- and post-rehabilitation phases&#44; divided into the sympathetic and parasympathetic periods&#44; from which it can be seen that the median did not change significantly between phases&#44; irrespective of the time of day&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows rMSSD values and standard deviation for the pre- and post-rehabilitation phases and the two periods&#44; from which it can be seen that mean rMSSD values remained virtually unchanged&#44; without statistical significance &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> shows SDNN values post-rehabilitation and in the period of sympathetic activity&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a> shows the distribution of SDNN values in the pre- and post-rehabilitation phases&#44; divided into the sympathetic and parasympathetic periods&#44; from which it can be seen that the median did not change significantly between phases&#44; irrespective of the time of day&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a> shows SDNN values and standard deviation for the pre- and post-rehabilitation phases and the two periods&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Chagas disease is responsible for a large number of sudden deaths in Latin America&#44; and is a classic example of intrinsic cardiac denervation&#46; It can thus be considered a true experimental model to assess autonomic regulation in humans&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cardiac rehabilitation</span><p id="par0195" class="elsevierStylePara elsevierViewall">Studies on physical activity in patients with cardiomyopathy have shown the benefits of regular exercise&#44; such as the 10&#8211;30&#37; increase in peak exercise capacity documented by Keteyian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> in patients with chronic heart failure &#40;CHF&#41;&#59; Belardinelli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> showed improvement in quality of life and clinical outcome&#44; while Hornig et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> reported improvement in endothelial function in CHF patients&#59; Hambrecht et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> showed benefits in plasma catecholamine levels&#44; and Piepoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> reported reduced morbidity and rehospitalization&#46; All these studies show reductions in the causes of mortality and improvements in cardiac function at rest&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cardiac rehabilitation in chronic Chagas cardiomyopathy</span><p id="par0200" class="elsevierStylePara elsevierViewall">The aim of this study was to assess changes in HRV in patients with CCC after a six-month cardiac rehabilitation program&#44; which can complement medical therapy&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The mean age of our study population was 57&#46;3 years&#44; with a predominance of women&#46; The sample thus included older individuals with a higher risk profile&#59; the predominance of women did not effect interpretation of the results&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Sousa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> studied the association between the HRV parameters SDNN&#44; rMSSD and pNN50 and level of physical activity in CD patients and controls&#46; This association was also studied in healthy individuals and CD patients using the International Physical Activity Questionnaire&#44; which assesses levels of physical activity independently of context&#44; and includes employment&#44; leisure and everyday activities&#46; The results showed that levels of normal physical activity correlated significantly with HRV indices in healthy individuals&#44; but not in CD patients&#44; suggesting that these patients&#8217; dysautonomia affects this relationship&#46; A similar result was found in our study&#44; with no significant changes in time-domain indices of HRV during the exercise program&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Oliveira and Pedrosa<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> analyzed ventilatory response during exercise among CCC patients using the Los Andes clinical and hemodynamic classification&#46; The results indicated that the progressive deterioration in ventilatory response of these patients is more evident when peak functional capacity &#40;VO<span class="elsevierStyleInf">2</span>&#41; is reduced than when changes are related to the Los Andes classification&#46; Montes de Oca et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> assessed peripheral muscle metabolic and structural characteristics in patients with advanced CD and analyzed whether they correlated with exercise performance&#59; they showed that such patients have decreased oxidative capacity and a shift to anaerobic metabolism in skeletal muscles&#46; They also suggest that muscle abnormalities are related to oxygen delivery&#44; which is probably reduced in part by the abnormal muscle microvasculature&#46; Oliveira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> compared gas exchange at rest and during exercise in CCC patients and healthy individuals grouped according to the Los Andes classification&#46; The results showed that the functional capacity of patients in the initial phase of CCC &#40;onset of cardiac involvement&#41; is higher than that of patients in an advanced phase and shows a decrease that follows the loss in cardiac-hemodynamic performance&#46; Mady et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> set out to characterize the functional capacity of asymptomatic CD patients with normal left ventricular function&#44; and found that while the patients had normal left ventricular systolic function at rest&#44; their functional capacity was significantly impaired during exercise&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">In a prospective randomized trial&#44; Lima et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> demonstrated that CD patients who underwent 12 weeks of exercise training showed improved functional capacity and quality of life compared to CD patients in the inactive control group&#46; Although the study did not measure peak oxygen uptake directly&#44; included only a small number of patients and had a short follow-up&#44; it showed increases in exercise tolerance&#44; distance covered on the 6-min walk test and estimated oxygen uptake&#44; as well as improvements in quality of life&#59; it thus represents an advance in research on the management of the cardiomyopathy associated with this important and neglected disease&#46; Lima et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> demonstrated that exercise training is not only effective but feasible and is not associated with significant adverse events&#46; Even in the context of the lack of effect on mortality and improvements in quality of life in the HF-ACTION study&#44; Lima et al&#46;&#8217;s study is relevant&#44; bearing in mind the specific mechanisms involved in the pathophysiology of CCC&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Our study assessed time-domain indices of HRV through 24-h Holter monitoring before and after a supervised exercise program&#46; Statistical analysis showed that SDNN&#44; pNN50 and rMSSD values did not change significantly &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; probably due to the large standard deviation observed&#44; poor patient adherence to the program&#44; resulting in a small sample&#44; and the short duration of the program&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Heart rate variability</span><p id="par0230" class="elsevierStylePara elsevierViewall">It is assumed that neuronal uptake of norepinephrine is impaired in hypertrophic cardiomyopathy due to reduced density of beta receptors&#44; as shown by Ianni and Mady&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Assessment of HRV has been used to diagnose not only physiological&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> but also psychological disorders&#46; A group of researchers analyzed whether the relationships between self-ratings of anxiety or emotional stress and parasympathetic nervous system components of HRV are independent of personality and cardiorespiratory fitness&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> They found an inverse relationship between perceived emotional stress during a week of exercise training and normalization of the high-frequency &#40;HF&#41; component of HRV &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;038&#41;&#44; which was independent of age&#44; gender&#44; trait anxiety and cardiorespiratory fitness&#59; they concluded that vagal modulation of heart period appears to be sensitive to the recent experience of persistent emotional stress&#44; regardless of a person&#39;s level of physical fitness and disposition toward experiencing anxiety&#46; HRV is normally used in sports medicine to assess cardiac autonomic adaptations to resistance training<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Differences in HRV between fit and unfit individuals have been thoroughly investigated&#46; Both time-domain and frequency-domain variables are higher in fit than in sedentary individuals&#44; indicating that the former have higher HRV&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Ribeiro and Rocha<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> assessed rMSSD and very low frequency&#44; low-frequency &#40;LF&#41; and HF indices and found no significant differences at rest between healthy sedentary men and active patients with hypertension and myocardial infarction&#44; suggesting that physical activity influenced autonomic modulation in these patients&#46; Such an effect was also reported by Kropf et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> who analyzed rMSSD at rest in active patients with coronary artery disease and healthy individuals and found no significant differences between the groups&#46; Furthermore&#44; these indices can be used to determine the influence on autonomic regulation of factors such as age&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> gender&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> and exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Heart rate variability and Chagas disease</span><p id="par0250" class="elsevierStylePara elsevierViewall">Sartori et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> assessed time- and frequency-domain indices in 81 CCC patients &#40;47 in the indeterminate phase&#44; of whom eight were male&#44; mean age 55&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;75 years&#44; and 34 in the chronic phase&#44; of whom eight were male&#44; mean age 57&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;59 years&#41; and compared them with a control group of 24 individuals &#40;seven male&#44; mean age 48&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;93 years&#41;&#46; The variables SDNN&#44; SDNNi and SDANN&#44; rMSSD&#44; pNN50&#44; and LF and HF were measured in all individuals through 24-h Holter monitoring and compared by ANOVA&#46; There were no statistically significant differences between the groups for SDNN&#44; SDNNi or HF &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; but significant differences were found for SDANN and LF &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; between controls and both groups of CD patients&#59; patients with CD presented statistically higher values for rMSSD and pNN50 than controls&#46; Spectral analysis showed a reduction in sympathetic response and global impairment of autonomic function as reflected in lower SDANN values in both types of CD patients&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">de Resende et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> assessed cardiac autonomic function in 84 individuals living in an endemic area through computerized analysis of HRV&#59; the study population consisted of 28 elderly patients with indeterminate CD&#44; 28 elderly individuals without the disease and 28 young adults&#46; There were no statistically significant differences between the groups in terms of systolic and diastolic diameters or left ventricular systolic function&#44; nor in mean RR interval&#46; There was a statistically significant difference in variance&#44; standard deviation&#44; variation coefficient and pNN50 between the young and the elderly&#44; but not between the two elderly groups&#46; The authors concluded that the elderly groups with and without CD did not differ in terms of baseline time-domain indices of cardiac autonomic function&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Another important aspect of CD is intrinsic denervation of the ANS&#44; as noted in the first studies on CD in Brazil&#46; K&#246;berle&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> a pioneer in the study of the ANS in CD&#44; adopted the technique of neuron counts in the 1950s&#44; and showed a reduction in the number of parasympathetic nerve cells&#59; he thus considered that Chagas cardiomyopathy involved reduced parasympathetic activity with predominance of the sympathetic&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">In autopsy studies&#44; K&#246;berle and colleages<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a> and Mott and Hagstrom<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> demonstrated lesions of the cardiac ANS in CD patients and observed that the nerve structures of the heart could be affected in a diffuse or focal manner&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">In an experimental study&#44; Tafuri and Raso<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> demonstrated the damage caused by CD to the sympathetic and parasympathetic nervous system&#59; ganglia lesions could involve all or part of the ganglion&#44; affecting intra- and extra-ganglion nerve fibers&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">In pharmacological and hemodynamic studies&#44; Amorim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> also suggested that the sympathetic nervous system was impaired in CCC patients&#44; making it clear that further studies are required to assess sympathetic neurons in these patients&#46; In this respect&#44; other diseases that affect the ANS&#44; such as familial amyloid polyneuropathy &#40;FAP&#41;&#44; may alter its classic manifestations when patients exercise&#46; FAP is a systemic amyloidosis of autosomal dominant inheritance characterized by ascending neuropathy of motor and sensory fibers and dysautonomia&#46; The condition is associated with reduced ANS nerve fiber density&#44; as reported by Sousa and Saraiva<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> These observations mean that wider-ranging studies involving both conditions are necessary&#44; with a prolonged program of supervised exercise training&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Cunha et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> assessed the role of the ANS in the pathogenesis of CCC&#46; They analyzed 75 patients divided into four groups based on the Los Andes classification &#40;IA&#44; IB&#44; II and III&#41; and measured norepinephrine in 24-h urine in 52 patients with CCC &#40;69&#37;&#41;&#44; 12 with other forms of heart disease &#40;in NYHA class IV&#41;&#44; the control group&#44; and ten normal individuals&#46; They performed 24-h Holter monitoring in 56 patients &#40;74&#46;6&#37;&#41; to assess HRV&#44; the parameters being analyzed and distributed according to the Los Andes and Lown classifications&#46; Norepinephrine levels were significantly higher &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; in the controls &#40;patients with non-Chagas heart disease&#41; than in group III &#40;CCC patients with heart failure&#41;&#46; Reduced HRV was observed in CD patients&#44; although this did not correlate with functional class&#46; The authors concluded that norepinephrine levels in CD patients in an advanced stage of cardiac involvement &#40;group III&#41; do not rise as in other forms of heart disease with a similar degree of cardiac involvement&#44; which probably reflects damage to the sympathetic nervous system&#46; HRV was reduced&#44; but one index of the parasympathetic system &#40;daytime and nighttime rMSSD&#41; was elevated in a group of patients with complex arrhythmias&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0285" class="elsevierStylePara elsevierViewall">The HRV parameters SDNN&#44; rMSSD and pNN50 in our patients with CCC did not undergo statistically significant changes after a six-month cardiac rehabilitation program&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0290" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "sec0020"
          "titulo" => "Patient selection"
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              "titulo" => "Diagnostic exams"
              "secciones" => array:1 [
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                  "identificador" => "sec0030"
                  "titulo" => "Laboratory tests"
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              "titulo" => "Chest X-ray"
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                  "identificador" => "sec0040"
                  "titulo" => "Resting electrocardiogram"
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              "identificador" => "sec0045"
              "titulo" => "Cardiopulmonary stress testing"
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                  "identificador" => "sec0050"
                  "titulo" => "Two-dimensional echocardiography with intracavitary Doppler"
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                  "titulo" => "Holter 24-h ambulatory electrocardiographic monitoring"
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          "titulo" => "Exercise program"
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          "titulo" => "Discussion"
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          "titulo" => "Cardiac rehabilitation"
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          "titulo" => "Cardiac rehabilitation in chronic Chagas cardiomyopathy"
        ]
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          "identificador" => "sec0090"
          "titulo" => "Heart rate variability"
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          "identificador" => "sec0095"
          "titulo" => "Heart rate variability and Chagas disease"
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          "titulo" => "Conclusion"
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          "titulo" => "Conflicts of interest"
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    "fechaRecibido" => "2011-07-28"
    "fechaAceptado" => "2012-10-11"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Chagas disease"
            1 => "Cardiac rehabilitation"
            2 => "Heart rate variability"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec166332"
          "palabras" => array:3 [
            0 => "Doen&#231;a de Chagas"
            1 => "Reabilita&#231;&#227;o card&#237;aca"
            2 => "Variabilidade da frequ&#234;ncia card&#237;aca"
          ]
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chagas disease &#40;CD&#41; is an infection caused by the protozoan flagellate <span class="elsevierStyleItalic">Trypanosoma cruzi</span>&#44; and transmitted by insects of the genera <span class="elsevierStyleItalic">Triatoma</span>&#44; <span class="elsevierStyleItalic">Rhodnius</span> and <span class="elsevierStyleItalic">Panstrongylus</span>&#46; The heart is affected to varying degrees by inflammatory and destructive lesions in atrial and ventricular myocardial fibers&#46; Several studies have demonstrated the benefits of exercise in patients with congestive heart failure &#40;CHF&#41;&#44; including reduced sympathetic tone and increased parasympathetic tone&#44; the result of reduced epinephrine and norepinephrine levels&#44; both at rest and during exercise&#44; including at submaximal levels&#46; It has been hypothesized that the increase in sympathetic arousal during exercise improves peripheral muscle metabolism&#46;</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The objectives of this study were to select patients with chronic Chagas cardiomyopathy &#40;CCC&#41; with dysautonomia on 24-h Holter monitoring&#44; assess autonomic function after rehabilitation&#44; and determine whether it resulted in reduced daytime levels of SDNN and increased daytime and nighttime levels of pNN50 and rMSSD&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analyzed time-domain indices of heart rate variability through 24-h Holter monitoring before and after a supervised exercise program&#46; We studied 18 CCC patients &#40;five men&#41;&#44; mean age 57&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;73 years&#44; followed at the CD outpatient clinic of the National Institute of Cardiology and IPEC&#47;Fiocruz in Rio de Janeiro&#44; Brazil&#44; between April 2009 and November 2010&#46; The following tests were used to assess the severity of CCC&#58; clinical examination&#44; functional evaluation by cardiopulmonary stress testing&#44; electrocardiogram and conventional Doppler echocardiography&#46; The exams were performed within a month of the start and end of the exercise program&#44; which consisted of 60-min sessions of aerobic exercise on a treadmill and resistance training three times a week for six months&#46; The goal was to reach the patients&#8217; heart rate target zone during training&#44; and their rating of perceived exertion was assessed by the modified Borg scale&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There were no statistically significant differences &#40;p&#62;0&#46;05&#41; in SDNN&#44; pNN50 and rMSSD&#44; probably due to the large standard deviation observed&#44; patients&#8217; poor adherence to the program and their low socioeconomic status&#44; resulting in a small sample&#44; and the short duration of the program&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Heart rate variability parameters in patients with CCC did not undergo statistically significant changes after a six-month cardiac rehabilitation program&#46;</p>"
      ]
      "pt" => array:2 [
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        "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A doen&#231;a de Chagas &#40;DC&#41; &#233; uma infe&#231;&#227;o causada pelo flagelado Trypanosoma cruzi&#44; transmitida por insetos do g&#233;nero Triatoma&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudos t&#234;m demonstrado o resultado ben&#233;fico da pr&#225;tica de exerc&#237;cios em portadores de insufici&#234;ncia card&#237;aca &#40;IC&#41;&#44; o seu efeito de redu&#231;&#227;o do t&#243;nus simp&#225;tico e o aumento do t&#243;nus parassimp&#225;tico relacionado com a redu&#231;&#227;o dos n&#237;veis de epinefrina e noraepinefrina&#46; Este estudo teve como objetivos&#58; detetar pacientes com cardiopatia chag&#225;sica cr&#243;nica &#40;CCC&#41; com disautonomia atrav&#233;s do Holter 24<span class="elsevierStyleHsp" style=""></span>h&#44; a fun&#231;&#227;o auton&#243;mica ap&#243;s reabilita&#231;&#227;o&#44; a redu&#231;&#227;o dos n&#237;veis de SDNN&#47;d e um aumento dos n&#237;veis de pNN50&#47;d e pNN50&#47;noite&#44; bem como de rMSSD&#47;d e noite&#46; Foi feita uma interven&#231;&#227;o tipo antes e depois com avalia&#231;&#227;o dos &#237;ndices de dom&#237;nios do tempo da variabilidade da frequ&#234;ncia card&#237;aca &#40;VFC&#41; antes e ao final do programa de exerc&#237;cios&#46; Foram estudados 18 pacientes&#44; sendo cinco homens&#44; com CCC e idade m&#233;dia de 57&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;73 anos&#44; no ambulat&#243;rio de DC do Instituto Nacional de Cardiologia &#40;INC&#41; entre abril de 2009 e novembro de 2010&#46; Os exerc&#237;cios foram&#58; atividade aer&#243;bica em esteira rolante e exerc&#237;cios contrarresistidos com dura&#231;&#227;o de 60<span class="elsevierStyleHsp" style=""></span>min e frequ&#234;ncia de tr&#234;s vezes por semana&#46; Os valores de SDNN&#44; pNN50 e rMSSD avaliados mostram-se quase inalterados sem signific&#226;ncia estat&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Conclu&#237;mos que os valores dos par&#226;metros de VFC em portadores de CCC n&#227;o se alteraram antes e ap&#243;s a interven&#231;&#227;o com um programa de reabilita&#231;&#227;o card&#237;aca de seis meses&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Amaral da Silva Souza MV&#44; et al&#46; Variabilidade da frequ&#234;ncia card&#237;aca&#58; an&#225;lise dos &#237;ndices no dom&#237;nio do tempo em portadores de cardiopatia chag&#225;sica cr&#243;nica&#44; antes e ap&#243;s um programa de exerc&#237;cios&#46; Rev Port Cardiol&#46; 2013&#46; <span class="elsevierStyleInterRef" href="http://dx.doi.org/10.1016/j.repc.2012.12.004">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;12&#46;004</span>&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Distribution of pNN50 values pre- and post-rehabilitation for the parasympathetic and sympathetic periods&#46; Post-Para&#58; post-rehabilitation-parasympathetic&#59; Post-Symp&#58; post-rehabilitation-sympathetic&#59; Pre-Para&#58; pre-rehabilitation-parasympathetic&#59; Pre-Symp&#58; pre-rehabilitation-sympathetic&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of rMSSD values pre- and post-rehabilitation for the parasympathetic and sympathetic periods&#46; Post-Para&#58; post-rehabilitation-parasympathetic&#59; Post-Symp&#58; post-rehabilitation-sympathetic&#59; Pre-Para&#58; pre-rehabilitation-parasympathetic&#59; Pre-Symp&#58; pre-rehabilitation-sympathetic&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab272112.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study population&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
        "tabla" => array:1 [
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Definition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean of RR intervals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SDNN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Standard deviation of RR intervals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SDNNi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean of the standard deviation of all RR intervals for all 5-min segments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SDANN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Standard deviation of average RR intervals calculated for 5-min segments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">rMSSD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Square root of the mean squared differences of successive RR intervals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pNN50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Percentage of differences between adjacent RR intervals &#62;50<span class="elsevierStyleHsp" style=""></span>ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab272111.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Definition of time-domain indices of heart rate variability&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Para&#46;&#58; parasympathetic&#59; Post&#58; post-rehabilitation&#59; Pre&#58; pre-rehabilitation&#59; Symp&#46;&#58; sympathetic&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Para&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Para&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Symp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Symp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab272115.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Mean pre- and post-rehabilitation pNN50 values and standard deviation for the daytime and nighttime periods&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Post-rehab&#58; post-rehabilitation&#59; SE&#58; standard error&#59; Symp&#46;&#58; period of sympathetic activity&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">rMSSD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Estimated value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">SE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">t&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Post-rehab&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;171733&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;003312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3170683&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07513279&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Symp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;9&#46;964565&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;838052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;4572228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1457007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab272109.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">rMSSD values post-rehabilitation and in the period of sympathetic activity&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Para&#46;&#58; parasympathetic&#59; Post&#58; post-rehabilitation&#59; Pre&#58; pre-rehabilitation&#59; Symp&#46;&#58; sympathetic&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Para&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">65&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>69&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Post&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Para&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>92&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">t&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
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                    0 => array:2 [
                      "titulo" => "Epidemiologia e controle da transmiss&#227;o vetorial da doen&#231;a de Chagas no Brasil"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;C&#46; Silveira"
                            1 => "D&#46;F&#46; Rezende"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Soc Bras Med Trop"
                        "fecha" => "1994"
                        "volumen" => "27"
                        "numero" => "Suppl&#46; III"
                        "paginaInicial" => "11"
                        "paginaFinal" => "22"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8008914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0010"
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                0 => array:2 [
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                      "titulo" => "Globaliza&#231;&#227;o&#44; iniq&#252;idade e doen&#231;a de Chagas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;C&#46; Dias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Cad Saude Publica"
                        "fecha" => "2007"
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                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S13"
                        "paginaFinal" => "S22"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17308713"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of Chagas disease in the Latin American immigrant population in a primary health centre in Barcelona &#40;Spain&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Soriano Arantes"
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                            2 => "M&#46; Verg&#233;s Navarro"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.actatropica.2009.07.014"
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                        "tituloSerie" => "Acta Trop"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19631185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                        "paginaInicial" => "165"
                        "paginaFinal" => "168"
                      ]
                    ]
                  ]
                ]
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                      "titulo" => "Predictors of impaired heart rate variability and clinical outcome in patients with acute myocardial infarction treated by primary angioplasty"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12040341"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "Attenuation of autonomic nervous system functions in hypertensive patients at rest and during orthostatic stimulation"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Karas"
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                            2 => "R&#46;A&#46; LeBlanc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Hypertens &#40;Greenwich&#41;"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "97"
                        "paginaFinal" => "104"
                      ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Heart rate variability&#44; trait anxiety&#44; and perceived stress among physically fit men and women"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;K&#46; Dishman"
                            1 => "Y&#46; Nakamura"
                            2 => "M&#46;E&#46; Garcia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Psychophysiol"
                        "fecha" => "2000"
                        "volumen" => "37"
                        "paginaInicial" => "121"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10831999"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0045"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular survey methods"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;B&#46; Rose"
                            1 => "H&#46; Blackburn"
                            2 => "R&#46;F&#46; Gillium"
                          ]
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                    ]
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                    0 => array:1 [
                      "Libro" => array:2 [
                        "titulo" => "World Health Organization&#44; monograph series&#44; 56"
                        "fecha" => "1982"
                      ]
                    ]
                  ]
                ]
              ]
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            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise training in patients with heart failure&#46; A randomized&#44; controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Keteyian"
                            1 => "A&#46;B&#46; Levine"
                            2 => "C&#46;A&#46; Brawner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1996"
                        "volumen" => "124"
                        "paginaInicial" => "1051"
                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8633818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized&#44; controlled trial of long-term moderate exercise training in chronic heart failure&#58; effects on functional capacity&#44; quality of life&#44; and clinical outcome"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Belardinelli"
                            1 => "D&#46; Georgiou"
                            2 => "G&#46; Cianci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1999"
                        "volumen" => "99"
                        "paginaInicial" => "1173"
                        "paginaFinal" => "1182"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10069785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical training improves endothelial function in patients with chronic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Hornig"
                            1 => "V&#46; Maier"
                            2 => "H&#46; Drexler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1996"
                        "volumen" => "93"
                        "paginaInicial" => "210"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8548890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure&#58; a randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Hambrecht"
                            1 => "S&#46; Gielen"
                            2 => "A&#46; Linke"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2000"
                        "volumen" => "283"
                        "paginaInicial" => "3095"
                        "paginaFinal" => "3101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10865304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise training meta-analysis of trials in patients with chronic heart failure &#40;ExTraMATCH&#41;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ExTraMATCH Collaborative"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;F&#46; Piepoli"
                            1 => "C&#46; Davos"
                            2 => "D&#46;P&#46; Francis"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.37938.645220.EE"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2004"
                        "volumen" => "328"
                        "paginaInicial" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14729656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Six-minute walk test in Chagas cardiomyopathy"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Sousa"
                            1 => "F&#46;A&#46; Botoni"
                            2 => "R&#46;R&#46; Britto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2007.01.034"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2008"
                        "volumen" => "125"
                        "paginaInicial" => "139"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17399822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilatory response during exercise among chronic Chagas cardiopathy patients"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;P&#46; Oliveira"
                            1 => "R&#46;C&#46; Pedrosa"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sao Paulo Med J"
                        "fecha" => "2006"
                        "volumen" => "124"
                        "paginaInicial" => "280"
                        "paginaFinal" => "284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17262161"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise performance and skeletal muscles in patients with advanced Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Montes de Oca"
                            1 => "S&#46;H&#46; Torres"
                            2 => "J&#46;G&#46; Loyo"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2004"
                        "volumen" => "125"
                        "paginaInicial" => "1306"
                        "paginaFinal" => "1314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15078739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gas exchange during exercise in different evolutional stages of chronic Chagas&#8217; heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;P&#46; Oliveira"
                            1 => "R&#46;C&#46; Pedrosa"
                            2 => "A&#46; Giannella-Neto"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2000"
                        "volumen" => "75"
                        "paginaInicial" => "481"
                        "paginaFinal" => "498"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11175473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximal functional capacity in patients with Chagas&#8217; cardiomyopathy without congestive heart failure"
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                          "etal" => true
                          "autores" => array:3 [
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                            1 => "B&#46;M&#46; Ianni"
                            2 => "E&#46; Arteaga"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1054/jcaf.2000.8828"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2000"
                        "volumen" => "6"
                        "paginaInicial" => "220"
                        "paginaFinal" => "224"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10997748"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial of the effects of exercise training in Chagas cardiomyopathy"
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                          "autores" => array:3 [
                            0 => "M&#46;M&#46; Lima"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfq123"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2010"
                        "volumen" => "12"
                        "paginaInicial" => "866"
                        "paginaFinal" => "873"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20675669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The indeterminate form of Chagas&#8217;disease&#46; Myths vs facts"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;M&#46; Ianni"
                            1 => "C&#46; Mady"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "1997"
                        "volumen" => "68"
                        "paginaInicial" => "147"
                        "paginaFinal" => "148"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9435350"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Redu&#231;&#227;o da variabilidade da freq&#252;&#234;ncia card&#237;aca em indiv&#237;duos de meia-idade e o efeito do treinamento de for&#231;a"
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                            1 => "F&#46;M&#46; Pereira"
                            2 => "M&#46;M&#46; Reboredo"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Bras Fisioter"
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                        "volumen" => "11"
                        "paginaInicial" => "113"
                        "paginaFinal" => "119"
                      ]
                    ]
                  ]
                ]
              ]
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            22 => array:3 [
              "identificador" => "bib0115"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Autonomic modulation of heart rate of young and postmenopausal women undergoing estrogen therapy"
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                          "autores" => array:3 [
                            0 => "V&#46;F&#46; Neves"
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                            2 => "L&#46; Gallo Jr&#46;"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "2007"
                        "volumen" => "40"
                        "paginaInicial" => "491"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17401492"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0120"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Progressive chronic Chagas heart disease ten years after treatment with anti-<span class="elsevierStyleItalic">Trypanosoma cruzi</span> nitroderivatives"
                      "autores" => array:1 [
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                            2 => "A&#46;C&#46; Vexenat"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Trop Med Hyg"
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                        "volumen" => "63"
                        "paginaInicial" => "111"
                        "paginaFinal" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11388500"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Indeterminate form of Chagas&#8217; disease&#58; considerations about diagnosis and prognosis"
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                          "etal" => false
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Soc Bras Med Trop"
                        "fecha" => "1998"
                        "volumen" => "31"
                        "paginaInicial" => "301"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9612022"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Doen&#231;a de Chagas&#58; a constru&#231;&#227;o de um fato cient&#237;fico e de um problema de sa&#250;de p&#250;blica no Brasil"
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                            2 => "L&#46;O&#46; Ferreira"
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                        "paginaInicial" => "347"
                        "paginaFinal" => "365"
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                ]
              ]
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            26 => array:3 [
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                        "paginaFinal" => "706"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15049110"
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                        "paginaInicial" => "271"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7649674"
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                        "tituloSerie" => "Clin Infect Dis"
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                        "paginaInicial" => "177"
                        "paginaFinal" => "179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9455528"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2013.03.003

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Year/Month	Html	Pdf	Total

2024 November	8	7	15
2024 October	41	38	79
2024 September	49	25	74
2024 August	57	29	86
2024 July	53	31	84
2024 June	36	27	63
2024 May	31	19	50
2024 April	31	21	52
2024 March	43	32	75
2024 February	33	36	69
2024 January	27	36	63
2023 December	23	30	53
2023 November	40	19	59
2023 October	30	18	48
2023 September	29	35	64
2023 August	38	25	63
2023 July	43	14	57
2023 June	34	16	50
2023 May	41	17	58
2023 April	25	4	29
2023 March	27	24	51
2023 February	24	17	41
2023 January	26	22	48
2022 December	36	19	55
2022 November	38	25	63
2022 October	28	13	41
2022 September	32	32	64
2022 August	34	31	65
2022 July	34	30	64
2022 June	32	22	54
2022 May	37	31	68
2022 April	38	28	66
2022 March	34	30	64
2022 February	23	24	47
2022 January	48	19	67
2021 December	29	26	55
2021 November	48	31	79
2021 October	88	50	138
2021 September	38	35	73
2021 August	48	36	84
2021 July	38	32	70
2021 June	42	11	53
2021 May	57	32	89
2021 April	137	42	179
2021 March	87	16	103
2021 February	91	19	110
2021 January	63	15	78
2020 December	54	6	60
2020 November	60	17	77
2020 October	31	11	42
2020 September	73	7	80
2020 August	33	8	41
2020 July	60	7	67
2020 June	43	4	47
2020 May	63	3	66
2020 April	62	19	81
2020 March	44	6	50
2020 February	91	17	108
2020 January	33	3	36
2019 December	39	9	48
2019 November	31	5	36
2019 October	37	4	41
2019 September	29	16	45
2019 August	40	4	44
2019 July	52	10	62
2019 June	26	6	32
2019 May	44	8	52
2019 April	28	16	44
2019 March	134	7	141
2019 February	100	11	111
2019 January	91	5	96
2018 December	95	4	99
2018 November	133	8	141
2018 October	252	18	270
2018 September	48	13	61
2018 August	41	9	50
2018 July	29	3	32
2018 June	50	14	64
2018 May	53	12	65
2018 April	26	9	35
2018 March	52	7	59
2018 February	16	3	19
2018 January	39	9	48
2017 December	52	6	58
2017 November	58	9	67
2017 October	38	7	45
2017 September	37	7	44
2017 August	44	13	57
2017 July	33	8	41
2017 June	37	8	45
2017 May	35	10	45
2017 April	64	4	68
2017 March	41	7	48
2017 February	35	4	39
2017 January	35	2	37
2016 December	33	10	43
2016 November	38	5	43
2016 October	33	20	53
2016 September	23	4	27
2016 August	12	3	15
2016 July	16	12	28
2016 June	9	9	18
2016 May	10	6	16
2016 April	46	7	53
2016 March	76	6	82
2016 February	83	21	104
2016 January	62	11	73
2015 December	76	15	91
2015 November	57	6	63
2015 October	47	12	59
2015 September	56	16	72
2015 August	48	11	59
2015 July	49	11	60
2015 June	34	6	40
2015 May	61	7	68
2015 April	149	15	164
2015 March	76	9	85
2015 February	39	4	43
2015 January	42	9	51
2014 December	58	12	70
2014 November	53	6	59
2014 October	61	17	78
2014 September	48	10	58
2014 August	42	12	54
2014 July	55	9	64
2014 June	54	12	66
2014 May	63	12	75
2014 April	45	7	52
2014 March	62	15	77
2014 February	75	17	92
2014 January	66	11	77
2013 December	65	12	77
2013 November	61	22	83
2013 October	78	13	91
2013 September	53	22	75
2013 August	65	32	97
2013 July	72	22	94
2013 June	49	24	73
2013 May	60	22	82
2013 April	15	5	20

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