A prospective observational study of autonomic dysfunction in cirrhosis of liver and its correlation with electrocardiography and echocardiography

Abstract

Background: Cirrhosis is a chronic liver condition characterized by hepatic fibrosis, anatomical distortion, and compromised liver function. Autonomic dysfunction (AD) is a significant concern due to its impact on cardiovascular stability, hemodynamic modulation, and patient prognosis. AD is characterized by irregularities in heart rate variability, impaired blood pressure management, and abnormal reflex reactions, which can increase the risk of cardiac events. Cirrhotic cardiomyopathy, characterized by compromised ventricular contractility and electromechanical dysfunction, is linked to autonomic abnormalities. ECG and ECHO are vital tools for assessing heart function in cirrhosis patients, revealing anatomical and functional heart alterations. Objective: This study aims to evaluate autonomic dysfunction in individuals with liver cirrhosis, its impact on ECG abnormalities, heart rate variability, blood pressure regulation, and cardiovascular reflexes, and its influence on various Child-Pugh and MELD score groups. It also seeks to identify potential predictors of autonomic dysfunction in cirrhosis, which could aid in early risk assessment and therapeutic management. Methods: A retrospective study was conducted on clinical records of 100 patients diagnosed with cirrhosis over an 18-month period, spanning from May 2023 to December 2024, at Shri B M Patil Medical College and Research Center, Vijayapura. The collected data encompassed patient demographics, clinical presentation at the time of admission, ECG findings (QTc interval), echocardiographic assessments, and indicators of autonomic dysfunction. Results: The study analyzed the age distribution and physiology of patients with heart conditions, focusing on the majority of patients aged 20-60 years. The majority were male, with 95% being male and 5% female. Pulse rates were categorized into three ranges: 81-100 bpm, 60-80 bpm, and 101-130 bpm. The Valsalva maneuver showed a similar distribution, with 52% falling in the 81-100 bpm range and 36% in the 60-80 bpm range. Blood pressure was measured using a blood pressure cuff, with higher pressure indicating a higher risk of heart failure. The study also examined blood pressure readings under three conditions: Supine BP (lying down), Standing BP, and Hand Grip BP. The most common reading in the supine position was 110/70, indicating normal resting BP. The ECG showed various normal and abnormal findings, with the majority having normal function. The Child-Pugh classification assessed the severity of chronic liver disease,

categorising patients into three classes: A (mild), B (moderate), and C (severe). In- patients with the chronic liver illness, particularly those are being considered for a liver

transplant, the risk of mortality was estimated using the MELD score.The study revealed that the majority of participants were middle-aged, the supine pulse rate showed a significant variation, and the rise in pulse rate upon standing was within the expected physiological range. Additionally, the MELD score served as a key indicator for determining the severity of liver disease. Statistical analysis confirmed significant deviations from expected baselines (p < 0.001). These findings highlight the strong link between autonomic dysfunction, cardiovascular abnormalities, and liver disease progression. Conclusion: The study reveals a significant gender disparity in the population, with 95% being males. Cardiovascular assessments show normal physiological responses, but some individuals show signs of autonomic dysfunction. ECG analysis reveals abnormalities in sinus rhythms, highlighting the need for continuous monitoring. Liver function assessments reveal a high prevalence of severe liver disease, necessitating urgent medical interventions. Early detection and management of these health issues are crucial for improving health outcomes. Future research should focus on lifestyle modifications, targeted treatments, and long-term monitoring.