Abstract
BackgroundReduced heart rate variability (HRV) is an independent predictor of mortality in patients with cirrhosis. However, conventional HRV indices can only be interpreted in individuals with normal sinus rhythm. In patients with recurrent premature ventricular complexes (PVCs), the predictive capacity of conventional HRV indices is compromised. Heart Rate Turbulence (HRT) represents the biphasic change of the heart rate after PVCs. This study was aimed to define whether HRT parameters could predict mortality in cirrhotic patients.Materials and Methods24 h electrocardiogram recordings were collected from 40 cirrhotic patients. Turbulence Onset was calculated as HRT indices. The enrolled patients were followed up for 12 months after the recruitment in relation to survival and/or transplantation.ResultsDuring the follow-up period, 21 patients (52.5%) survived, 12 patients (30%) died and 7 patients (17.5%) had liver transplantation. Turbulence Onset was found to be strongly linked with mortality on Cox regression (Hazard ratio = 1.351, p < 0.05). Moreover, Turbulence Onset predicted mortality independently of MELD and Child-Pugh’s Score.ConclusionThis study provides further evidence of autonomic dysfunction in cirrhosis and suggests that HRT is reliable alternative to HRV in patients with PVCs.
Highlights
Patients with cirrhosis exhibit systemic manifestations such as autonomic dysfunction which affects adaptation to physiologic and pathologic challenges
Reduced Heart rate variability (HRV) is widely reported in cirrhotic patients (Ates et al, 2006; Newton et al, 2006; Mani et al, 2009; Bhogal et al, 2019; Jansen et al, 2019; Satti et al, 2019), by Bhogal et al (2019) who demonstrated that the HRV indices can predict mortality in cirrhotic patients, independent of their Model for End-Stage Liver Disease (MELD) (Model of EndStage Liver Dysfunction) score - one of the most used grading system used to predict short term mortality
The recruitment and follow-up of patients was initially for an investigation to assess if physio-markers such as body temperature variability and HRV can predict survival in cirrhotic patients (Monfredi et al, 2014)
Summary
Patients with cirrhosis exhibit systemic manifestations such as autonomic dysfunction which affects adaptation to physiologic and pathologic challenges. Reduced HRV is widely reported in cirrhotic patients (Ates et al, 2006; Newton et al, 2006; Mani et al, 2009; Bhogal et al, 2019; Jansen et al, 2019; Satti et al, 2019), by Bhogal et al (2019) who demonstrated that the HRV indices can predict mortality in cirrhotic patients, independent of their MELD (Model of EndStage Liver Dysfunction) score - one of the most used grading system used to predict short term mortality These indices were only linked to mortality in cirrhotic patients with normal sinus rhythm. This study was aimed to define whether HRT parameters could predict mortality in cirrhotic patients
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