title: Heart rhythm turbulence and NT-proBNP in decompensated liver cirrhosis--a pilot study.
abstract: BACKGROUND
  Heart rhythm turbulence (HRT) is a novel tool for evaluation of cardiovascular mortality. Liver cirrhosis is associated with hemodynamic and myocardial disturbances termed cirrhotic cardiomyopathy. In the stable stage of liver cirrhosis, systolic and myocardial dysfunction is correlated with brain natriuretic peptide (BNP). The aim was to evaluate HRT and its correlation with NT-proBNP, echocardiographic and biochemical parameters in patients with decompensation of liver cirrhosis.
  
  
  METHODS
  The study included 18 patients with decompensated liver cirrhosis and 18 healthy volunteers. Participants underwent echocardiography and 24-hour ECG monitoring. Serum NT-proBNP and other biochemical parameters were measured. Turbulence onset (TO) and turbulence slope (TS) were used to indicate HRT.
  
  
  RESULTS
  Mean HR (87/min vs. 75/min), TO (-0.385% vs. -0.92%), NT-proBNP (304.85 pg/ml vs. 83.2 pg/ml), LAd (42.5 mm vs. 34.5 mm), RVdd (29.5 mm vs. 25 mm), SPAP (36.5 mmHg vs. 22.5 mmHg) were significantly (p<0.05) higher in patients with liver cirrhosis. Patients with normal TO and TS had better stage in Child-Pugh classification (P=0.04) than patients with abnormal values. Significant negative correlation was found between creatinine and TO, and between mean HR and TS, and significant positive correlation was found between LAd and TS. LV diastolic dysfunction was noted in a majority of cirrhotic patients (n=16).
  
  
  CONCLUSIONS
  Patients with decompensated cirrhosis had elevated levels of NT-proBNP and LV diastolic dysfunction. TO values in cirrhotic patients differed significantly from the control group. These findings can indicate risk of symptomatic heart failure development and may be a marker of cirrhotic cardiomyopathy. HRT parameters seem not to be appropriate death predicators.
authors.affiliation: Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Lodz, Poland. polczak@mp.pl
authors.forename: Adam Rafał
authors.initials: AR
authors.lastname: Poliwczak
authors.forename: Jolanta
authors.initials: J
authors.lastname: Białkowska
authors.forename: Marlena
authors.initials: M
authors.lastname: Broncel
authors.forename: Marzena
authors.initials: M
authors.lastname: Koziróg
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Dworniak
authors.forename: Kornelia
authors.initials: K
authors.lastname: Kotecka
authors.forename: Maciej
authors.initials: M
authors.lastname: Jabłkowski
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010865:Pilot Projects; D016019:Survival Analysis
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain