Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis

Christian Jansen, Baravan Al-Kassou, Jennifer Lehmann, Alessandra Pohlmann, Johannes Chang, Michael Praktiknjo, Georg Nickenig, Christian P Strassburg, Jan W Schrickel, René Andrié, Markus Linhart, Jonel Trebicka

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Resumé

BACKGROUND: 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.

METHODS AND PATIENTS: 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.

RESULTS: 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.

CONCLUSION: Parameters of HRT are closely associated with deterioration of cirrhosis and might be helpful in its prediction.

OriginalsprogEngelsk
Artikelnummere0195631
TidsskriftPLOS ONE
Vol/bind13
Udgave nummer4
Antal sider10
ISSN1932-6203
DOI
StatusUdgivet - 1. apr. 2018

Fingeraftryk

liver cirrhosis
Liver Cirrhosis
Liver
Deterioration
heart rate
Turbulence
deterioration
Ambulatory Electrocardiography
International Normalized Ratio
Ventricular Premature Complexes
ascites
heart diseases
endpoints
albumins
morbidity
Biopsy
biopsy
Albumins
Electrocardiography
Medical imaging

Citer dette

Jansen, C., Al-Kassou, B., Lehmann, J., Pohlmann, A., Chang, J., Praktiknjo, M., ... Trebicka, J. (2018). Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis. PLOS ONE, 13(4), [e0195631]. https://doi.org/10.1371/journal.pone.0195631
Jansen, Christian ; Al-Kassou, Baravan ; Lehmann, Jennifer ; Pohlmann, Alessandra ; Chang, Johannes ; Praktiknjo, Michael ; Nickenig, Georg ; Strassburg, Christian P ; Schrickel, Jan W ; Andrié, René ; Linhart, Markus ; Trebicka, Jonel. / Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis. I: PLOS ONE. 2018 ; Bind 13, Nr. 4.
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title = "Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis",
abstract = "BACKGROUND: 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.METHODS AND PATIENTS: 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.RESULTS: 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.CONCLUSION: Parameters of HRT are closely associated with deterioration of cirrhosis and might be helpful in its prediction.",
author = "Christian Jansen and Baravan Al-Kassou and Jennifer Lehmann and Alessandra Pohlmann and Johannes Chang and Michael Praktiknjo and Georg Nickenig and Strassburg, {Christian P} and Schrickel, {Jan W} and Ren{\'e} Andri{\'e} and Markus Linhart and Jonel Trebicka",
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month = "4",
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Jansen, C, Al-Kassou, B, Lehmann, J, Pohlmann, A, Chang, J, Praktiknjo, M, Nickenig, G, Strassburg, CP, Schrickel, JW, Andrié, R, Linhart, M & Trebicka, J 2018, 'Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis', PLOS ONE, bind 13, nr. 4, e0195631. https://doi.org/10.1371/journal.pone.0195631

Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis. / Jansen, Christian; Al-Kassou, Baravan; Lehmann, Jennifer; Pohlmann, Alessandra; Chang, Johannes; Praktiknjo, Michael; Nickenig, Georg; Strassburg, Christian P; Schrickel, Jan W; Andrié, René; Linhart, Markus; Trebicka, Jonel.

I: PLOS ONE, Bind 13, Nr. 4, e0195631, 01.04.2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis

AU - Jansen, Christian

AU - Al-Kassou, Baravan

AU - Lehmann, Jennifer

AU - Pohlmann, Alessandra

AU - Chang, Johannes

AU - Praktiknjo, Michael

AU - Nickenig, Georg

AU - Strassburg, Christian P

AU - Schrickel, Jan W

AU - Andrié, René

AU - Linhart, Markus

AU - Trebicka, Jonel

PY - 2018/4/1

Y1 - 2018/4/1

N2 - BACKGROUND: 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.METHODS AND PATIENTS: 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.RESULTS: 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.CONCLUSION: Parameters of HRT are closely associated with deterioration of cirrhosis and might be helpful in its prediction.

AB - BACKGROUND: 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.METHODS AND PATIENTS: 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.RESULTS: 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.CONCLUSION: Parameters of HRT are closely associated with deterioration of cirrhosis and might be helpful in its prediction.

U2 - 10.1371/journal.pone.0195631

DO - 10.1371/journal.pone.0195631

M3 - Journal article

C2 - 29634776

VL - 13

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 4

M1 - e0195631

ER -

Jansen C, Al-Kassou B, Lehmann J, Pohlmann A, Chang J, Praktiknjo M et al. Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis. PLOS ONE. 2018 apr 1;13(4). e0195631. https://doi.org/10.1371/journal.pone.0195631