Assessment of Autonomic Function by Phase Rectification of RRInterval Histogram Analysis in Chagas Disease

BACKGROUND: In chronic Chagas disease (ChD), impairment of cardiac autonomic function bears prognostic implications. Phase‑rectification of RR-interval series isolates the sympathetic, acceleration phase (AC) and parasympathetic, deceleration phase (DC) influences on cardiac autonomic modulation. OBJECTIVE: This study investigated heart rate variability (HRV) as a function of RR-interval to assess autonomic function in healthy and ChD subjects. METHODS: Control (n = 20) and ChD (n = 20) groups were studied. All underwent 60-min head-up tilt table test under ECG recording. Histogram of RR-interval series was calculated, with 100 ms class, ranging from 600–1100 ms. In each class, mean RR-intervals (MNN) and root-mean-squared difference (RMSNN) of consecutive normal RR-intervals that suited a particular class were calculated. Average of all RMSNN values in each class was analyzed as function of MNN, in the whole series (RMSNN(T)), and in AC (RMSNN(AC)) and DC (RMSNN(DC)) phases. Slopes of linear regression lines were compared between groups using Student t-test. Correlation coefficients were tested before comparisons. RMSNN was log-transformed. (α < 0.05). RESULTS: Correlation coefficient was significant in all regressions (p < 0.05). In the control group, RMSNN(T), RMSNN(AC), and RMSNN(DC) significantly increased linearly with MNN (p < 0.05). In ChD, only RMSNN(AC) showed significant increase as a function of MNN, whereas RMSNN(T) and RMSNN(DC) did not. CONCLUSION: HRV increases in proportion with the RR-interval in healthy subjects. This behavior is lost in ChD, particularly in the DC phase, indicating cardiac vagal incompetence.