Cardiac autonomic modulation in children with severe liver disease, before and after liver transplantation

Renata Salatini; Joice Amaral; Rodrigo Daminello Raimundo; Fernando Rocha; Luiz Carlos de Abreu; Mauro Morais; Uenis Tannuri; Ana Cristina Tannuri

doi:10.21037/tp-21-273

Cardiac autonomic modulation in children with severe liver disease, before and after liver transplantation

Transl Pediatr. 2022 Apr;11(4):438-447. doi: 10.21037/tp-21-273.

Authors

Renata Salatini¹, Joice Amaral², Rodrigo Daminello Raimundo³, Fernando Rocha³, Luiz Carlos de Abreu^{3

4}, Mauro Morais⁵, Uenis Tannuri⁶, Ana Cristina Tannuri^{2

6}

Affiliations

¹ Department of Clinical Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
² Department of Pediatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil.
³ Design of Studies and Scientific Writing Laboratory, Centro Universitario FMABC, Sao Paulo, Brazil.
⁴ Department of Integrated Health Education, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
⁵ Design of Studies and Scientific Writing Laboratory, Federal University of Acre, Acre, Brazil.
⁶ Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), University of Sao Paulo Medical School, Sao Paulo, Brazil.

Abstract

Background: The cardiovascular system is directly influenced by the autonomic nervous system (ANS); its changes affect heart rate variability (HRV) and are sensitive indicators of physiological changes. Autonomic dysfunction (AD) is manifested in up to 60% of patients with cirrhosis. Therefore, we aim to analyze the indexes of HRV pre- and post-surgery of children submitted for liver transplantation (LT).

Methods: HRV, in children of both genders from 6 months of age to 10 years, that attended at the pediatric surgery clinic in the queue for LT at the Children's Institute were analyzed. To access HRV we analyzed indexes such as standard deviation of the RR intervals (SDNN), root-mean-square of the successive normal sinus RR interval difference (RMSSD), low frequency (LF), high frequency (HF), and LF/HF.

Results: The analysis of the behavior of cardiac autonomic modulation, in the period prior to LT and after surgery, showed an increase in HRV linear parameters SDNN, TINN (triangular interpolation of NN interval histogram), HFms². In the time domain, there was also an increase in the HFms² index.

Conclusions: The analysis of the period preceding LT and two months after surgery showed an increase in the HRV linear parameters representing a global HRV improvement. In the time domain, there was also an increase in the HFms² index, parasympathetic tone of the HRV.

Keywords: Autonomic nervous system (ANS); child; heart rate variability (HRV); liver diseases; liver transplantation (LT).