Abstract：
OBJECTIVE: More than a century since its discovery, the pathogenesis of Chagas heart disease (CHD) remains incompletely understood. The role of derangements in the autonomic control of the heart in triggering malignant arrhythmia before the appearance of contractile ventricular impairment was reviewed.
RESULTS: Although previous investigations had demonstrated the anatomical and functional consequences of parasympathetic dysautonomia upon the heart rate control, only recently, coronary microvascular disturbances and sympathetic denervation at the ventricular level have been reported in patients and experimental models of CHD, exploring with nuclear medicine methods their impact on the progression of myocardial dysfunction and cardiac arrhythmias. More important than parasympathetic impaired sinus node regulation, recent evidence indicates that myocardial sympathetic denervation associated with coronary microvascular derangements is causally related to myocardial injury and arrhythmia in CHD. Additionally, 123I-MIBG imaging is a promising tool for risk stratification of progression of ventricular dysfunction and sudden death.
RESULTS: Although previous investigations had demonstrated the anatomical and functional consequences of parasympathetic dysautonomia upon the heart rate control, only recently, coronary microvascular disturbances and sympathetic denervation at the ventricular level have been reported in patients and experimental models of CHD, exploring with nuclear medicine methods their impact on the progression of myocardial dysfunction and cardiac arrhythmias. More important than parasympathetic impaired sinus node regulation, recent evidence indicates that myocardial sympathetic denervation associated with coronary microvascular derangements is causally related to myocardial injury and arrhythmia in CHD. Additionally, 123I-MIBG imaging is a promising tool for risk stratification of progression of ventricular dysfunction and sudden death.
摘要：
目标：自发现以来的一个多世纪，查加斯心脏病（CHD）的发病机制尚不完全清楚。回顾了在出现收缩性心室损害之前，心脏自主神经控制紊乱在触发恶性心律失常中的作用。
结果：尽管以前的研究已经证明了副交感神经自主神经失调对心率控制的解剖和功能后果，只是最近,在冠心病患者和实验模型中已经报道了心室水平的冠状动脉微血管紊乱和交感神经支配，用核医学方法探讨它们对心肌功能障碍和心律失常进展的影响。比副交感神经受损更重要的窦房结调节，最近的证据表明，与冠状动脉微血管紊乱相关的心肌交感神经支配与冠心病的心肌损伤和心律失常有因果关系。此外,123I-MIBG成像是用于心室功能障碍和猝死进展的风险分层的有前途的工具。
结果：尽管以前的研究已经证明了副交感神经自主神经失调对心率控制的解剖和功能后果，只是最近,在冠心病患者和实验模型中已经报道了心室水平的冠状动脉微血管紊乱和交感神经支配，用核医学方法探讨它们对心肌功能障碍和心律失常进展的影响。比副交感神经受损更重要的窦房结调节，最近的证据表明，与冠状动脉微血管紊乱相关的心肌交感神经支配与冠心病的心肌损伤和心律失常有因果关系。此外,123I-MIBG成像是用于心室功能障碍和猝死进展的风险分层的有前途的工具。
