Low heart rate variability from 10-s electrocardiograms is associated with development of non-alcoholic fatty liver disease

Abstract

Reduced heart rate variability (HRV) is reflective of autonomic imbalance. However, its impact on non-alcoholic fatty liver disease (NAFLD) is unknown. We investigated the association between 10-s HRV and incident NAFLD. A cohort of 154,286 Korean adults with no NAFLD at baseline were followed up. 10-s electrocardiograms were used to estimate two time-domain HRV, the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences in RR intervals (RMSSD). Hepatic steatosis (HS) and liver fibrosis were assessed using ultrasonography and the fibrosis-4 index (FIB-4). A total of 27,279 incident HS (median follow up of 4.2 years) and 1250 incident HS plus high FIB-4 (median follow up of 4.2 years) cases were identified at follow-up. The multivariable adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) in a model with time-dependent variables for incident HS, comparing the lowest quintile to the highest and reference quintile of the RMSSD, was 1.43 (1.37–1.49), and the corresponding HR for incident HS plus intermediate/high FIB-4 was 1.70 (1.35–2.15). Similarly, SDNN was inversely associated with incident HS and HS plus intermediate/high FIB-4. The results were similar using the NAFLD fibrosis score. Autonomic imbalance assessed by HRV may help to identify individuals at a high risk of HS and its progression and warrant further studies.

Nonalcoholic Fatty Liver Disease Is Related to Abnormal Corrected QT Interval and Left Ventricular Hypertrophy in Chinese Male Steelworkers

“…Another possible mechanism for the association between the prolonged QTc interval and NAFLD may be due to the autonomic imbalance that occurs in NAFLD [ 47 , 48 ]. The duration of the QT interval and QT dispersion is also known to be influenced by the autonomic nervous system [ 42 ].…”

Changes in heart rate variability over time from symptom onset of transient global amnesia

“…These findings are significant as SD NN and RMSSD are key indicators of HRV, reflecting different aspects of ANS function. Specifically, SD NN represents overall HRV and is considered a marker of both sympathetic and parasympathetic activity, while RMSSD primarily reflects parasympathetic (vagal) activity, which is linked to heart rate deceleration 36 . The autonomic adjustment observed suggests a phase of recovery from the acute stress of TGA, where the initial heightened autonomic activity diminishes as the body returns to a stable state 37 .…”

Assessment of sympathovagal balance by HRV analysis in alcoholic and nonalcoholic fatty liver disease patients

“…[ 11 ] Decreased heart rate variability reflects the imbalance in autonomic function. [ 12 ] Earlier studies have concluded that decreased HRV is directly associated with cardiometabolic risk factors leading to cardiovascular morbidity and mortality. [ 12 ] Impairment of HRV increases with increasing severity of liver disease as well as autonomic dysfunction in liver disease increases the risk of mortality rate fivefold.…”

“…[ 12 ] Earlier studies have concluded that decreased HRV is directly associated with cardiometabolic risk factors leading to cardiovascular morbidity and mortality. [ 12 ] Impairment of HRV increases with increasing severity of liver disease as well as autonomic dysfunction in liver disease increases the risk of mortality rate fivefold. [ 10 ] LF and HF were found to be more in alcoholic fatty liver disease than the nonalcoholic fatty liver disease patients, but it was found to be under the normal range.…”