Non-Alcoholic Cirrhosis and Heart Rate Variability: A Systematic Mini-Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Information Sources
2.3. Search Strategy
2.4. Study Selection
2.5. Data Items
2.6. Data Analysis and Risk of Bias in Individual Studies
2.7. HRV Analysis
3. Results
4. Discussion
4.1. Effects of Cirrhosis on HRV
4.2. Child–Pugh and HRV
5. Conclusions
Limitations and Recommendations for Future Studies
Author Contributions
Funding
Conflicts of Interest
References
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Study | Non-Alcoholic LC Group | Healthy Control Group | Methods: HRV Analysis | Results | Conclusion |
---|---|---|---|---|---|
Ates, F. et al. (2006) | n = 30 (19 males, 11 females; 52 ± 13 yrs. old, Child–Pugh’s class A n = 5, class B n = 11, class C n = 14; HBV infection n = 22, HCV infection n = 8) | n = 28 (16 males, 12 females; 47 ± 11 yrs. old); Mean ± SD | 24 h Holter ECG-Software NR; FFT; Time domain (mean NN, SDNN, SDANN, RMSSD, pNN50) | <HRV (NN, SDNN, SDANN, r-MSSD, and pNN50) LC patients versus healthy controls; >autonomic dysfunction, >severity of disease; <HRV non-survivors versus survivors | Time-domain HRV parameters may provide additional important information on the prognosis of disease and HRV analysis may be a helpful adjunct to the routine clinical evaluation in patients with chronic liver disease. |
Lazzeri, C. et al. (1997) | n = 12 with ascites (7 males, 5 females, 52 ± 6 yrs. old, Child–Pugh’s class B n = 5, class C n = 7; cryptogenic n = 2, HBV infection n = 2, chronic HCV infection n = 8) | n = 12 (45–72 yrs. old) | 24 h Holter ECG (ELA-TEC 1.0, ELA Medical, Segrate, Italy); time-domain (SDNN, SDANN, pNN50, RMSSD) and frequency-domain PSA, FFT (LF, HF, ms² n.u., LF/HF ratio) | <HRV-time-domain LC patients versus healthy controls | Patients with non-alcoholic cirrhosis and ascites have disrupted autonomic regulation of cardiovascular function, with reduced vagal tone and impaired sympathetic drive to the heart. |
Negru, R. D. et. al. (2015) | n = 12 (HCV infection) | n = 10 (61.1 ± 8.17 yrs. old) | 2 h from the 24 h Holter ECG (6-12AM); Kubios HRV 2.2 (Department of Applied Physics, University of Eastern Finland, Kuopio, Finland); time- (SDNN, RMSSD, NN50, pNN50, RRTri, TINN) and frequency- (TP, VLF, LF, HF, LF/HF ratio) domain. Non-linear parameters (Poincaré plot—SD1, SD2, recurrence plots, recurrence rate, DET, Shannon Entropy, ApEn, SampEn, MSE, DFA, alfa 1, alfa 2, D2) | >HRV (SDNN, rMSSD, NN50, pNN50, VLF, HF, TP) patients with hepatitis C virus cirrhosis versus control group | Fractal analysis and mostly detrended fluctuations alpha1: more sensitive and associated with promising results for an early diagnostic of the autonomic dysfunction associated with the hepatitis C virus etiology of cirrhosis. Linear and nonlinear HRV parameters cannot be used as predictors of the autonomic dysfunction associated with LC. |
Newton, J. et al. (2006) | n = 57 PBC female patients (NR age) | n = 57 age- and sex-matched | 5 min ECG (limb leads I or II); LabVIEW data acquisition card type DAQ-1200 (National Instruments, Newbury, UK); PSA: FFT-based (TP, VLF, LF, HF, LF/HF ratio); BRS: cross-spectral density (a LF, a HF) | <HRV non-transplanted PBC patient group versus age- and sex-matched controls. <-> HRV cirrhotic and pre-cirrhotic in non-transplanted PBC group | Transplanted patients retain lowered HRV, which may have implications for post-transplant survival |
Iga, A.et al. 2003 | n = 50 (LC group: 27 males, 23 females; mean age: 62.8 ± 7.8 yrs.; HBV infection n = 4, HCV infection n = 40, chronic HBV and HCV coinfection = 2, PBC n = 4; Child–Pugh A LC-A group n = 20 patients 14 males, 6 females; Child–Pugh B LC-B group n = 12, 8 males, 4 females; Child–Pugh C LC-C group n = 18, 11 males, 7 females). | n = 50 age-matched (N group: 33 males, 17 females; mean age: 65.1 ± 8.3 yrs. old | 24 h Holter ECG; MemCalc Ver. 2.5 (Suwa Trust, Tokyo, Japan). Frequency-domain, FFT (LF, HF, LF/HF ratio); 1/f fluctuations (regression analysis); day-time (8–20 h) and night-time (20–8 h) | <LF HF LC versus N, >LF/HF LC versus N, <LF HF LC-C versus LC-A and LC-B groups, >LF/HF LC-C versus LC-A LC-B. N group: >HF power at night, <LF/HF ratio at night, normal circadian rhythm; LC-A group: >HF power and >LF/HF ratio during daytime. LC-C group: <LF and HF powers during daytime and night-time, circadian rhythm disappeared, >LF/HF ratio entire day | Autonomic abnormalities appear in the early stages of LC detectable by I-metaiodobenzylguanidine myocardial scintigraphy and HRV |
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Anaize Tonon do Amaral, J.; Salatini, R.; Arab, C.; Abreu, L.C.; Valenti, V.E.; Monteiro, C.B.M.; Tannuri, U.; Tannuri, A.C.A. Non-Alcoholic Cirrhosis and Heart Rate Variability: A Systematic Mini-Review. Medicina 2020, 56, 116. https://doi.org/10.3390/medicina56030116
Anaize Tonon do Amaral J, Salatini R, Arab C, Abreu LC, Valenti VE, Monteiro CBM, Tannuri U, Tannuri ACA. Non-Alcoholic Cirrhosis and Heart Rate Variability: A Systematic Mini-Review. Medicina. 2020; 56(3):116. https://doi.org/10.3390/medicina56030116
Chicago/Turabian StyleAnaize Tonon do Amaral, Joice, Renata Salatini, Claudia Arab, Luiz Carlos Abreu, Vitor E. Valenti, Carlos B. M. Monteiro, Uenis Tannuri, and Ana Cristina Aoun Tannuri. 2020. "Non-Alcoholic Cirrhosis and Heart Rate Variability: A Systematic Mini-Review" Medicina 56, no. 3: 116. https://doi.org/10.3390/medicina56030116