Autonomic dysfunction is common in liver cirrhosis and is associated with cardiac dysfunction and mortality: prospective observational study
São Paulo med. j
;
140(1): 71-80, Jan.-Feb. 2022. tab, graf
Article
in English
| LILACS
| ID: biblio-1357462
ABSTRACT
ABSTRACT BACKGROUND:
Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis.OBJECTIVE:
To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality. DESIGN ANDSETTING:
Prospective observational study conducted in the Federal University of São Paulo.METHOD:
A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters.RESULTS:
The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100.CONCLUSION:
Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Arrhythmias, Cardiac
/
Electrocardiography, Ambulatory
Type of study:
Observational study
/
Prognostic study
/
Risk factors
Limits:
Child
/
Humans
Language:
English
Journal:
São Paulo med. j
Journal subject:
Cirurgia Geral
/
Cincia
/
Ginecologia
/
Medicine
/
Medicina Interna
/
Obstetr¡cia
/
Pediatria
/
Sa£de Mental
/
Sa£de P£blica
Year:
2022
Type:
Article
Affiliation country:
Brazil
/
United States
Institution/Affiliation country:
Department of Cardiology, Instituto do Coração (InCor)/BR
/
Department of Echocardiology/BR
/
Department of Electrophysiology/BR
/
Department of Gastroenterology/BR
/
Department of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil/BR
/
Department of Industrial Engineering/BR
/
Department of Medicine/BR
/
Department of Surgery/BR
/
Liver Center, Beth Israel Deaconess Medical Center/US
Similar
MEDLINE
...
LILACS
LIS