Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Department of Internal Medicine II, University of Bonn, Bonn, Germany.
PLoS One. 2018 Apr 10;13(4):e0195631. doi: 10.1371/journal.pone.0195631. eCollection 2018.
In patients with liver cirrhosis, cardiac dysfunction is frequent and is associated with increased morbidity and mortality. Cardiac dysfunction in cirrhosis seems to be linked to autonomic dysfunction. This study investigates the role of autonomic dysfunction assessed by Heart Rate Turbulence (HRT) analyses in patients with liver cirrhosis.
Inclusion criteria was (1) diagnosis of cirrhosis by clinical, imaging or biopsy and (2) evaluation by standard 12-lead-ECG and 24h holter monitoring and (3) at least 3 premature ventricular contractions. The exclusion criterion was presence of cardiac diseases, independent of liver cirrhosis. Biochemical parameters were analysed using standard methods. HRT was assessed using Turbulence onset (TO) and slope (TS). The endpoint was deterioration of liver cirrhosis defined as increased MELD and readmission for complications of liver cirrhosis.
Out of 122 cirrhotic patients, 82 patients (63% male) with median Child score of 6 (range 5-12) and median MELD score of 10 (range 6-32) were included. Increasing Child score, INR and decreasing albumin were correlated with TO. In addition, decompensated patients with ascites showed more abnormal TO and TS. During the observation period, patients with more abnormal TO showed significantly higher rate of rising MELD Score at 6 months (p = 0.03). Nevertheless, at least in our collective HRT-parameters were not independent predictors of deterioration of cirrhosis.
Parameters of HRT are closely associated with deterioration of cirrhosis and might be helpful in its prediction.
在肝硬化患者中，心脏功能障碍很常见，并且与发病率和死亡率的增加有关。肝硬化中心脏功能障碍似乎与自主神经功能障碍有关。本研究调查了心率震荡（HRT）分析评估的自主神经功能障碍在肝硬化患者中的作用。
纳入标准为（1）通过临床、影像学或活检诊断为肝硬化，（2）进行标准 12 导联心电图和 24 小时动态心电图监测，（3）至少有 3 次室性期前收缩。排除标准为存在与肝硬化无关的心脏疾病。采用标准方法分析生化参数。使用 Turbulence onset（TO）和 slope（TS）评估 HRT。终点为肝硬化恶化，定义为 MELD 增加和因肝硬化并发症再入院。
在 122 例肝硬化患者中，纳入了 82 例（63%为男性）患者，其中位 Child 评分为 6（范围 5-12），中位 MELD 评分为 10（范围 6-32）。Child 评分增加、INR 升高和白蛋白降低与 TO 相关。此外，伴有腹水的失代偿患者的 TO 和 TS 更异常。在观察期间，TO 异常更多的患者在 6 个月时 MELD 评分升高的发生率明显更高（p = 0.03）。然而，至少在我们的研究中，HRT 参数不是肝硬化恶化的独立预测因素。
HRT 参数与肝硬化恶化密切相关，可能有助于预测肝硬化恶化。
