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Which heart rate variability index is an independent predictor of mortality in cirrhosis?
Amar S Bhogal1, Michele De Rui2, Donatella Pavanello2
1Division of Medicine, University College London, London, UK.
Insights
Reduced heart rate variability (HRV) predicts mortality in liver cirrhosis patients. Two specific HRV indices, SD2 and cSDNN, independently forecast survival, offering valuable prognostic tools.
Area of Science:
- Cardiology
- Hepatology
- Medical Prognostics
Background:
- Liver cirrhosis is linked to diminished heart rate variability (HRV), signifying compromised cardiovascular control.
- Various HRV indices exist for quantification, necessitating identification of the most effective prognostic markers.
Purpose of the Study:
- To ascertain which heart rate variability (HRV) index best predicts mortality in liver cirrhosis patients.
- To determine if HRV's predictive ability for mortality is independent of hepatic failure severity (MELD score).
Main Methods:
- Electrocardiogram (ECG) recordings of 10-minute duration were obtained from 74 cirrhosis patients.
- Heart rate fluctuations were analyzed using statistical, geometrical, and non-linear methods.
- Patients were monitored for 18 months for mortality or liver transplantation.
Main Results:
- During follow-up, 32% of patients died or underwent transplantation.
- SDNN, cSDNN, SD1, SD2, and spectral indices predicted survival.
- SD2 and cSDNN independently predicted survival, irrespective of MELD score, age, gender, beta-blocker use, or liver disease etiology.
Conclusions:
- Two heart rate variability (HRV) indices, SD2 and cSDNN, predict mortality in liver cirrhosis patients independently of MELD.
- These identified HRV indices serve as valuable tools for predicting patient survival.
Background:
Liver cirrhosis is associated with reduced heart rate variability (HRV), which indicates impaired integrity of cardiovascular control in this patient population. There are several different indices for HRV quantification. The present study was designed to: 1) determine which of the HRV indices is best at predicting mortality in patients with cirrhosis; 2) verify if such ability to predict mortality is independent of the severity of hepatic failure.
Methods:
Ten minutes electrocardiogram was recorded in 74 patients with cirrhosis. Heart rate fluctuations were quantified using statistical, geometrical and non-linear analysis. The patients were followed-up for 18months and information was collected on the occurrence of death/liver transplantation.
Results:
During the follow-up period, 24 patients (32%) died or were transplanted for hepatic decompensation. Cox's regression analysis showed that SDNN (total HRV), cSDNN (corrected SDNN), SD1 (short-term HRV), SD2 (long-terms HRV) and spectral indices could predict survival in these patients. However, only SD2 and cSDNN were shown to be independent of MELD in predicting survival. The prognostic value of HRV indices was independent of age, gender, use of beta blockers, and the aetiology of liver disease.
Conclusion:
Two HRV indices were identified that could predict mortality in patients with cirrhosis, independently of MELD. These indices are potentially useful tools for survival prediction.
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