Bustos N, Giubergia F, Mora C, Lara C, Urzúa Á, Cattaneo M, Poniachik J, Vera DB, Gajardo AI. Heart rate variability in the clinical assessment of patients with chronic liver disease. World J Hepatol 2025; 17(7): 106291 [DOI: 10.4254/wjh.v17.i7.106291]
Corresponding Author of This Article
Abraham IJ Gajardo, MD, PhD, Professor, Program of Pathophysiology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Independencia 1027, Casilla 70058, Santiago 8380453, Region Metropolitana, Chile. aij.gajardo@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jul 27, 2025; 17(7): 106291 Published online Jul 27, 2025. doi: 10.4254/wjh.v17.i7.106291
Heart rate variability in the clinical assessment of patients with chronic liver disease
Nicolás Bustos, Flavia Giubergia, Cristóbal Mora, Christian Lara, Álvaro Urzúa, Máximo Cattaneo, Jaime Poniachik, Daniela B Vera, Abraham IJ Gajardo
Nicolás Bustos, Flavia Giubergia, Cristóbal Mora, Abraham IJ Gajardo, Program of Pathophysiology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Region Metropolitana, Chile
Christian Lara, Álvaro Urzúa, Máximo Cattaneo, Jaime Poniachik, Daniela B Vera, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Region Metropolitana, Chile
Abraham IJ Gajardo, Intensive Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Region Metropolitana, Chile
Author contributions: Urzúa A, Cattaneo M, Poniachik J, Vera DB and Gajardo AIJ contributed to the conceptualization and design of this review; Giubergia F, Bustos N, Mora C, Lara C and Gajardo AIJ performed the data/evidence acquisition and interpretation; Cattaneo M, Bustos N, Mora C, Lara C and Gajardo AIJ drafting the manuscript; Urzúa A, Cattaneo M, Poniachik J, Vera DB and Gajardo AIJ critically reviewed the manuscript making significant intellectual contributions. All the authors approved the final version of this manuscript.
Supported by National Agency of Research and Development (ANID), Government of Chile (https://anid.cl/about-us/), through the Initiation in Research FONDECYT grant No. 11241548.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abraham IJ Gajardo, MD, PhD, Professor, Program of Pathophysiology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Independencia 1027, Casilla 70058, Santiago 8380453, Region Metropolitana, Chile. aij.gajardo@gmail.com
Received: February 21, 2025 Revised: April 10, 2025 Accepted: June 10, 2025 Published online: July 27, 2025 Processing time: 154 Days and 9.3 Hours
Abstract
Autonomic dysfunction (AD) is frequently observed in cirrhotic patients and is associated with poor clinical outcomes and prognoses. Heart rate variability (HRV), a noninvasive tool for assessing autonomic nervous system balance, has been extensively studied in a variety of conditions, including chronic liver disease (CLD); however, no recent reviews have focused on its role in CLD. This article examines the mechanisms of AD in CLD and the foundation for HRV assessment, highlighting its diagnostic, prognostic, and therapeutic applications in CLD, including liver transplantation (LT). Changes in HRV, particularly in patients with cirrhotic complications, and its prognostic significance throughout the natural history of CLD are summarized. We show that HRV is consistently reduced in CLD patients, reflecting AD, and is inversely correlated with liver disease severity. Also, low HRV is associated with complications such as hepatic encephalopathy, ascites, and portal hypertension. Moreover, evidence indicates that reduced HRV is an independent risk factor for mortality and circulatory instability in CLD. Furthermore, treatment with beta-blockers and LT improves HRV, underscoring its potential role in patient management. While further studies are needed, HRV emerges as a promising tool for the comprehensive evaluation and clinical management of patients with CLD, offering insights into disease progression and therapeutic response.
Core Tip: Autonomic dysfunction (AD) is common in cirrhotic patients and is linked to poor outcomes. Heart rate variability (HRV), a noninvasive measure of autonomic balance, could be useful in managing chronic liver disease (CLD) patients. This article explores AD mechanisms, HRV assessment, and its diagnostic, prognostic, and therapeutic relevance in CLD, including liver transplantation.
