Heart rate variability as a marker for autonomic dysfunction in liver cirrhosis

Introduction: Liver cirrhosis is a disease with a consistent improvement in terms of survival, in recent years. Accordingly, special attention was paid to the complications that could be developed during a prolonged evolution time, one of these complications being the autonomic dysfunction. This study aimed at evaluating the potential correlations between heart rate variability (HRV) parameters and liver cirrhosis severity and etiology, and estimating the type of autonomic dysfunction induced, through a 24-hour Holter monitoring. Methods: Our study included 48 patients with liver cirrhosis and 30 control subjects, all of them submitted to a 24-hour ECG recording. Time-domain parameters (mean RR, SDNN, SDNN index and SDANN index) and frequency-domain HRV parameters (high frequency – HF, low frequency – LF and LF/HF ratio) were analyzed. Results: The imbalance between the two autonomic components was reflected in significantly lower values recorded for the time-domain parameters (mean RR, SDNN, SDNN index and SDANN index), LF (P = 0.02) and LF/HF ratio (P < 0.001) in cirrhosis versus controls, except for HF, r-MSSD and pNN50, thus suggesting a markedly decreased sympathetic activity, with the vagal component less impaired. Alcoholic etiology recorded the most important impairment of HRV parameters, while analysis with respect to the severity of cirrhosis, expressed as the Child – Pugh class, suggested that impairment of HRV parameters is progressive from Child A to Child C class, but only with a slight significance for some frequency-domain parameters. Conclusions: Time-domain parameters of Holter monitoring appeared as the most sensitive ones for revealing HRV disturbances, while frequency-domain parameters unveiled the autonomic imbalance between sympathetic and parasympathetic influences. More severe liver disease, in terms of Child-Pugh class, and alcoholic etiology have been associated with a greater HRV impairment. The 24-hour ECG monitoring of HRV parameters could help establishing some noninvasive prognostic markers in patients with liver cirrhosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)