title: Intramyocardial adrenergic activation in chagasic cardiomyopathy and coronary artery disease.
abstract: BACKGROUND
  Myocardial norepinephrine is altered in left ventricular impairment. In patients with Chagas' cardiomyopathy (CC), this issue has not been addressed.
  
  
  OBJECTIVE
  To determine the level of myocardial norepinephrine in patients with CC and compare it in patients with coronary artery disease, and to relate myocardial norepinephrine to left ventricular ejection fraction (LVEF).
  
  
  METHODS
  We studied 39 patients with CC, divided into group 1: 21 individuals with normal LVEF and group 2: 18 individuals with decreased LVEF. Seventeen patients with coronary artery disease were divided into group 3: 12 individuals with normal LVEF and group 4: 5 individuals with decreased LVEF. Two-dimensional echocardiography was used to measure LVEF. Myocardial norepinephrine was determined by high-performance liquid chromatography.
  
  
  RESULTS
  Myocardial norepinephrine in CC with and without ventricular dysfunction was 1.3±1.3 and 6.1±4.2 pg/μg noncollagen protein, respectively (p<0.0001); in coronary artery disease with and without ventricular dysfunction, it was 3.3±3.0 and 9.8±4.2 pg/μg noncollagen protein, respectively (p<0.0001). A positive correlation was found between LVEF and myocardial norepinephrine concentration in the patients with Chagas' cardiomyopathy (p<0.01, r = 0.57) and also in those with coronary artery disease (p<0.01, r=0.69). A significant difference was demonstrated between norepinephrine concentrations in patients with normal LVEF (groups 1 and 3; p = 0.0182), but no difference was found in patients with decreased LVEF (groups 2 and 4; p = 0.1467).
  
  
  CONCLUSIONS
  In patients with Chagas' cardiomyopathy and normal global ejection fraction there is an early cardiac denervation, when compared to coronary artery disease patients.
authors.affiliation: Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Rua Doutor Diogo de Faria 1077-62, Vila Clementino, São Paulo-SP, Brazil. lnastari@cardiol.br
authors.forename: Luciano
authors.initials: L
authors.lastname: Nastari
authors.forename: Felix Jose Alvarez
authors.initials: FJ
authors.lastname: Ramires
authors.forename: Vera Maria Cury
authors.initials: VM
authors.lastname: Salemi
authors.forename: Barbara Maria
authors.initials: BM
authors.lastname: Ianni
authors.forename: Fábio
authors.initials: F
authors.lastname: Fernandes
authors.forename: Célia Maria
authors.initials: CM
authors.lastname: Strunz
authors.forename: Edmundo
authors.initials: E
authors.lastname: Arteaga
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
mesh_terms: D002598:Chagas Cardiomyopathy / Q000378:metabolism* / Q000503:physiopathology; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D003324:Coronary Artery Disease / Q000378:metabolism* / Q000503:physiopathology; D004812:Epidemiologic Methods; D005260:Female; D006321:Heart / Q000294:innervation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000737:chemistry*; D009638:Norepinephrine / Q000032:analysis*; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D009638:Norepinephrine