Association between autonomic modulation of heart rate and the disease severity in children with severe liver disease

Author(s)

Joice Anaize Tonon do Amaral

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2020-03-03

Examining board members

Ana Cristina Aoun Tannuri; Claudio Leone; Isabel Cristina Esposito Sorpreso; Vitor Engracia Valenti

• Advisor: Ana Cristina Aoun Tannuri

Abstract

Introduction: The AVB is the main indication for pediatric liver transplantation, responsible for 60% of indications in the major centers. Because the liver is the great \"laboratory\" of the human body, with an important role in the metabolism of substances and homeostasis of the organism, its involvement by cirrhosis generates a series of requirements and imbalances in various organs and systems. There are already studies on the autonomic nervous system in children in different conditions, however, there is no literature that studies the autonomic nervous system of children with liver disease. Aim: To analyze a cardiac autonomic modulation with the degree of severity of the disease in children with severe hepatic disease. Methods: Children with a diagnosis of biliary atresia waiting for liver transplantation, both sexes, from 6 months to 3 years of age, who were waiting list transplantation at the Children\'s Institute, were analyzed by the PELD regarding the severity of the disease. Healthy children were evaluated for the control group. Data analysis of cardiac modulation without time domain and used (pNN50, SDNN and RMSSD) and domain of the frequency and use of low frequency LF components and high frequency HF. A geometric analysis will be performed using the RRtri, TINN, SD1, SD2 and SD1 / SD2 ratios. In the non-linear indexes DFA ?1 and ?2, DET, REC, D2 and symbolic analysis. RESULTS: When comparing the two groups of children, the results were significant in the time domain indices: SDNN (p = 0.001), RMSSD (<0.01), NN50 (p = 0.03), pNN50 (p = 0.04). In the frequency domain of the indexes LF (ms²) and HF (ms²) presented values of p <0.001. In the geometric indices, RRTri and TINN both with p <0.001, and SD1 (p = 0.003) and SD2 (p = 0.001). The correlation of the PELD with the indexes RMSSD and SD1 the values respectively were r = -0.46 (p = 0.008) and r = -0.45 (p = 0.009). Conclusion: There is a change in heart rate variability in both sympathetic modulation and parasympathetic modulation, demonstrating a decrease in HRV and a higher prognosis of morbidity in children with biliary atresia. (AU)

• FAPESP's process: 16/10570-7 - Autonomic heart modulation association with PELD in children liver disease
• Grantee: Joice Anaize Tonon do Amaral
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)