Assessment of autonomic dysfunctions in patients with non-cirrhotic portal fibrosis

Abstract

Introduction and Aim: Autonomic dysfunction has been observed in both alcoholic and nonalcoholic chronic liver diseases. Autonomic (both parasympathetic and sympathetic) functions are affected in these diseases. However, there are few studies on autonomic dysfunctions in non-cirrhotic portal fibrosis (NCPF) compared with cirrhosis. Therefore, in the present study we have assessed autonomic functions in patients NCPF and cirrhosis. Materials and Methods: Autonomic function such as heart rate variability (HRV) and conventional autonomic function tests (AFTs) were assessed in 3 groups of patients. Groups 1 included patients with NCPF, Group 2 were those with compensated cirrhosis (Child A) and Group 3 included age, sex and BMI-matched healthy volunteers. Patients with diabetes, cardiac or renal insufficiency, neurological disorders, on diuretics / beta blockers for at least 2 weeks prior to AFTs were excluded. Results: Total Power (TP) of the HRV spectrum was reduced significantly in NCPF (p<0.001) and cirrhosis participants (p<0.001) when compared to the controls. LF-HF and VLF was significantly reduced in both NCPF and cirrhosis when compared to controls. LF-HF ratio was reduced in NCPF and increased in cirrhosis and the difference between them was statistically significant. There was no difference in the Mean RR of the three groups. When compared to the controls, RMSSD, SDNN, NN50 was significantly reduced in NCPF and Cirrhosis. The difference in pNN50 was significantly reduced in Cirrhosis (p<0.001) when compared to controls. Among Conventional AFTs, heart rate response to standing expressed as 30:15 ratio was reduced in NCPF and Cirrhosis. ?DBP IHG was similar in all the three groups Conclusion: The present study reports the presence of autonomic imbalance in patients suffering from NCPF and hepatic cirrhosis, which is more prominent in cirrhosis. Sympathovagal imbalance, decreased HRV, decreased vagal and increased sympathetic modulations of cardiac functions in these patients predispose them to higher CV risks and CV morbidities. Keywords: Non-cirrhotic portal fibrosis; Cirrhosis; Autonomic function tests; Heart rate variability; Sympathovagal balance.