The Relationship of Heart Rate Variability with Severity and Prognosis of Cirrhosis

Ateş, Fehmi; Topal, Ergün; Koşar, Feridun; Karıncaoğlu, Melih; Yıldırım, Bülent; Aksoy, Yüksel; Aladağ, Murat; Harputluoğlu, Murat; Demirel, Ulvi; Alan, Hakan; Hilmioğlu, Fatih

doi:10.1007/s10620-006-9073-9

Cited by 65 publications

(84 citation statements)

References 25 publications

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“…It seems that autonomic nervous system disorder may be a worse prognostic factor in advanced stages of liver cirrhosis, including patients with cirrhotic encephalopathy [12,17,18]. Some authors suggest that decrease in HRV parameters is an independent mortality risk factor in patients with liver cirrhosis [14,16]. So far, reasons for this phenomenon are not clearly explained.…”

Section: Discussionmentioning

confidence: 99%

“…The HRV is used as a mortality predictor in patients with ischaemic heart disease (IHD), after myocardial infarction (MI), arterial hypertension (HA), and heart failure (HF) [7][8][9][10][11]. A few studies have proved that abnormalities in HRV parameters are observed in liver cirrhosis [12][13][14]. Independently of the aetiology of liver cirrhosis, reduction in HRV is noted.…”

Section: Introductionmentioning

confidence: 99%

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Heart rate variability in patients with decompensated liver cirrhosis – a pilot study

Białkowska¹,

Poliwczak²,

Jabłkowski³

et al. 2012

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Introduction: Cirrhosis is associated with many disorders of the cardiovascular system defined "cirrhotic cardiomyopathy". They concern, among others autonomic imbalance. One of the ways to evaluate these disorders is to study the heart rate variability (HRV). Abnormal HRV values occur in hypertension, ischemic heart disease, post myocardial infarction and heart failure. Are one of the prognostic factors. Aim: Evaluation of parameters of HRV in 24-hour Holter monitoring in patients with decompensated cirrhosis. Material and methods: The study included 18 patients with decompensated cirrhosis and the control group consisted of 16 healthy subjects. Enrolled were performed 24-hour Holter ECG. Heart rate variability parameters, were estimated during whole recording period, separately for night resting and morning activity hours. Results: There have been significant differences in almost all, both time and frequency HRV parameters between the two groups for follow-up clock. Similar results were obtained by comparing the HRV separately for the night and morning with a control group. The control group achieved statistically significant differences between all the time parameters of HRV at night compared with morning. Frequency parameters showed no significant differences. In patients with cirrhosis demonstrated such differences for the average time NN, SDNN, SDANN, Tr-I, Tinn and ULF. In a 24-hour observation of HRV parameters did not differ significantly depending on the grade in Child-Pugh classification. Conclusions: Patients with decompensated cirrhosis showed significantly lower HRV parameters than healthy volunteers. In addition, disturbances of circadian distribution showed

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart rate variability in patients with decompensated liver cirrhosis – a pilot study

Białkowska¹,

Poliwczak²,

Jabłkowski³

et al. 2012

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“…HRV is also decreased in patients with chronic liver disease (6,12,17,25,32,37,39). Plasma concentrations of inflammatory cytokines are increased in these patients, even in the absence of active infection (19,50,55), and this activation of inflammatory mediators might explain the decrease in HRV observed in these patients.…”

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confidence: 91%

“…Contrary to the predictions of the classical concept of homeostasis, the output of a wide variety of physiological systems, such as the normal heart beat, fluctuates in a complex manner, even under resting conditions (1,21). Deceased variability or increased regularity of the cardiac rhythm has been reported in different clinical settings associated with systemic inflammation and increased production of inflammatory cytokines, such as sepsis, diabetes mellitus, ischemic heart disease, congestive heart failure, and hepatic failure; in these contexts, it is a negative predictor of outcome (5,6,(22)(23)(24)31).…”

mentioning

confidence: 99%

Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy

Mani¹,

Montagnese²,

Jackson³

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

111

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Mani AR, Montagnese S, Jackson CD, Jenkins CW, Head IM, Stephens RC, Moore KP, Morgan MY. Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy. Am J Physiol Gastrointest Liver Physiol 296: G330 -G338, 2009. First published November 20, 2008 doi:10.1152/ajpgi.90488.2008.-Heart rate variability (HRV) is reduced in several clinical settings associated with either systemic inflammation or neuropsychiatric impairment. The possibility that the changes in HRV observed in patients with neuropsychiatric impairment might relate to the overproduction of inflammatory cytokines does not seem to have been considered in the studies undertaken to date. HRV is decreased in patients with liver cirrhosis but its relationship to the impairment of neuropsychiatric performance, commonly observed in these patients, is unknown. The aim of this study was to investigate the relationship between HRV, hepatic encephalopathy, and production of inflammatory cytokines in patients with cirrhosis. Eighty patients with cirrhosis [53 men, 27 women; mean (Ϯ1SD) age 54 Ϯ 10 yr], classified as neuropsychiatrically unimpaired or as having minimal or overt hepatic encephalopathy, and 11 healthy subjects were studied. HRV was assessed by applying Poincaré plot analysis to the R-R interval series on a 5-min ECG. Inflammatory cytokines (TNF-␣, IL-6, IL-10, and IL-12) were measured in a subgroup of patients. Long-term R-R variability was significantly decreased in the patients with cirrhosis, in parallel with the degree of neuropsychiatric impairment (P Ͻ 0.01) and independently of the degree of hepatic dysfunction (P ϭ 0.011). The relative risk of death increased by 7.7% for every 1-ms drop in this variable. Plasma levels of IL-6 significantly correlated with indexes of both HRV and neuropsychiatric performance. The changes observed in HRV and in neuropsychiatric status in patients with cirrhosis are significantly correlated, most likely reflecting a common pathogenic mechanism mediated by inflammatory cytokines.

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“…These observations were attributed to a systemic hyperdynamic state, resulting from an accumulation of endogenous vasodilators like nitric oxide leading to vascular hyporesponsiveness, [14][15][16] reduced HR variability because of developing an autonomic neuropathy, 6,17,18 and using β-blockers. 19 Cirrhotic patients exhibit a blunted response to physiologic and pharmacologic β-receptor stimulation because of a reduction in the number of cell membrane β-receptors and multiple downstream defects in β-receptor signaling pathways.…”

Section: Significance Of Chronotropic Incompetencementioning

confidence: 99%

Chronotropic Incompetence on Dobutamine Stress Echocardiography in Candidates for a Liver Transplant

Singhal

Mukerji

Thomaides

et al. 2013

Exp Clin Transplant

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Objectives: We evaluated dobutamine stress echocardiography as an initial screening test for a cardiac evaluation before a liver transplant. Materials and Methods: We retrospectively examined 111 liver transplant candidates who had undergone previous cardiac evaluation; 30 of whom had undergone a liver transplant. Results: Eighty patients (72.1%) completed a dobutamine stress echocardiography (41 chronotropically competent, 39 incompetent), while 31 patients (27.9%) required us to terminate early. Overall, 68 patients (61%) were on β-blockers (21 required early dobutamine stress echocardiography termination, 30 chronotropically incompetent, and 17 competent). Patient results were normal. Thirty patients underwent a liver transplant. Among candi dates requiring termination of early dobutamine stress echocardiography, posttransplant cardiac events included 1 fatal acute myocardial infarction, 1 nonfatal acute myocardial infarction, and 1 idiopathic cardiomyopathy. Among chrono tro pically incompetent patients, 2 patients had transient bradycardia, and among those who were chronotropically competent, 1 had refractory atrial fibrillation, and 1 had transient bradycardia. Conclusions: Nearly 50% of patients with end-stage liver disease may not reach the target heart rate. Early termination of dobutamine stress echocardiography because of cardiac symptoms or significant echocardiographic changes have more effect in predicting postoperative cardiac events, but further evaluation is required even if their target heart rate is close to that desired. Lower target heart rate may be acceptable in chronotropically incompetent individuals provided they are asymptomatic, have no echocardiographic changes, or cardiovascular risk factors, especially if they are on β-blockers.

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The Relationship of Heart Rate Variability with Severity and Prognosis of Cirrhosis

Cited by 65 publications

References 25 publications

Heart rate variability in patients with decompensated liver cirrhosis – a pilot study

Heart rate variability in patients with decompensated liver cirrhosis – a pilot study

Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy

Chronotropic Incompetence on Dobutamine Stress Echocardiography in Candidates for a Liver Transplant

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