Heart rate variability in the clinical assessment of patients with chronic liver disease

Table 2 Summary findings of heart rate variability regarding the natural history and clinical management of chronic liver disease

Potential clinical utility in CLD	Main HRV findings
Diagnosis	↓ HRV in CLD patients compared with healthy subjects. HRV is a risk factor for MASLD development
Disease staging	↓ HRV values are associated with greater severity when evaluated using the Child-Pugh score. Prothrombin activity and plasma albumin are correlated with SDNN
Assessment of associated complications	↓ HRV is associated with encephalopathy, ascites, esophageal varices, and cardiac dysfunction, and it could be a prognostic marker in hepatocellular carcinoma
Mortality risk	↓ HRV increases mortality risk in cirrhotic patients, independently of MELD, Child-Pugh score, and other risk factors
Management in LT	Some HRV parameters normalize after LT. In combination with MELD score, HRV predicts 1-year survival after LT
Follow-up of medical treatment	The use of beta-blockers ↑ HRV in patients with CLD

CLD: Chronic liver disease; LT: Liver transplant; HRV: Heart rate variability; SDNN: Standard deviation of “NN” intervals; MELD: Model for end-stage liver disease.