• Carolina Frade Magalhães Girardin Pimentel, Ricardo Salvadori, Ana Cristina de Castro Amaral Feldner, Miguel Osman de Aguiar, Adriano Miziara Gonzalez, Gabriel Ribas Branco, Marcel Superbia, Michelle Lai, Daniel de Oliveira Mota, Maria Lucia Cardoso Gomes Ferraz, Wilson Mathias, and Mario Kondo.
• MD, PhD. Professor, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
• Sao Paulo Med J. 2022 Jan 1; 140 (1): 71-80.

BackgroundAlthough 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.ObjectiveTo evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality.Design And SettingProspective observational study conducted in the Federal University of São Paulo.MethodA 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.ResultsThe 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.ConclusionReduced 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.

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