Autonomic dysfunction is common in liver cirrhosis and is associated with cardiac dysfunction and mortality: prospective observational study

• Published in: São Paulo medical journal Vol. 140; no. 1; pp. 71 - 80
• Main Authors: Pimentel, Carolina Frade Magalhães Girardin, Salvadori, Ricardo, Feldner, Ana Cristina de Castro Amaral, Aguiar, Miguel Osman de, Gonzalez, Adriano Miziara, Branco, Gabriel Ribas, Superbia, Marcel, Lai, Michelle, Mota, Daniel de Oliveira, Ferraz, Maria Lucia Cardoso Gomes, Mathias, Wilson, Kondo, Mario
• Format: Journal Article
• Language: Portuguese
• Published: Associação Paulista de Medicina - APM 01-02-2022
• Subjects: MEDICINE, GENERAL & INTERNAL; Heart rate; Autonomic dysfunction; Cirrhotic cardiomyopathy; Mortality; Liver cirrhosis; Heart diseases; Heart rate variability
• DOI: 10.1590/1516-3180.2021.0111.r1.18052021
• ISSN: 1806-9460

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 AND SETTING: 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.