Key result
Lower HRV metric SDANN correlates with worse liver disease severity in patients with nonalcoholic cirrhosis.
Why the study?
Autonomic nervous system activity in cirrhotic portal hypertension is linked to hyperdynamic circulation, prompting investigation into the correlation between heart rate variability parameters and the degree of portal hypertension.
Is heart rate variability associated with disease severity and portal hypertension in patients with nonalcoholic cirrhosis?
Cross-Sectional (n=157)
No
Is heart rate variability associated with disease severity and portal hypertension in patients with nonalcoholic cirrhosis?
Time-domain HRV parameters correlate with the degree of portal hypertension and liver dysfunction in patients with cirrhosis, suggesting autonomic nervous system alteration plays a role in hepatic decompensation.
Answers are grounded in this paper and cite their sources.
HRV-severity association in cirrhosis is hypothesis-generating; leaves open prospective validation before any clinical use.
INTRODUCTION: Autonomic nervous system activity in cirrhotic portal hypertension is linked to hyperdynamic circulation. Heart rate variability (HRV) is a validated noninvasive method to assess the sympathovagal balance. To investigate the correlation between HRV parameters and degree of portal hypertension, we studied a cohort of patients with cirrhosis accounting for etiology and treatments. PATIENTS AND METHODS: In this cross-sectional, observational cohort study, 157 outpatients of both sex with nonalcoholic cirrhosis were assessed by upper gastrointestinal endoscopy to search for esophagogastric varices. Twenty-four-hour electrocardiogram Holter monitoring with 3 HRV parameters measurement [SD of the NN intervals, root mean square successive difference of NN intervals, and SD of the averages of NN intervals (SDANN)] according to time-domain analysis were performed in all patients. Sixteen patients with large esophagogastric varices underwent measurements of the HVPG and assessment of HRV parameters at baseline and after 45 days on carvedilol. RESULTS: The liver dysfunction, expressed by Child-Pugh class or MELD score, was directly related to root mean square successive difference of NN intervals and inversely related to SDANN. Presence of ascites was inversely related to SDANN and to SD of the NN intervals. Treatment with carvedilol had an inverse relation with SDANN. Presence and size of esophagogastric varices had an inverse relation to SDANN and SD of the NN intervals. Upon multivariate analysis the associations between SDANN and Child-Pugh class, size of varices and ascites were confirmed. In the subgroup of 16 patients undergoing HVPG measurement, pressure gradient was unrelated to heart rate and HRV parameters. CONCLUSIONS: Time-domain HRV parameters in patients with cirrhosis, confirm the autonomic nervous system alteration, and their correlation to the degree of portal hypertension suggesting a role of the ANS in hepatic decompensation.
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Miceli et al. (2023) conducted a cross-sectional in Nonalcoholic cirrhosis (n=157). 24-hour ECG Holter monitoring (Heart Rate Variability assessment) was evaluated on Correlation between SDANN (SD of the averages of NN intervals) and Child-Pugh class (R -0.447, p=<0.0001). In patients with nonalcoholic cirrhosis, time-domain heart rate variability parameters such as SDANN were significantly and inversely correlated with liver disease severity (Child-Pugh class, R=-0.447, p<0.0001).
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