Factors associated with a prolonged QT interval in liver cirrhosis patients

doi:10.1016/j.jelectrocard.2010.10.034

Journal of Electrocardiology

Volume 44, Issue 2, March–April 2011, Pages 105-108

https://doi.org/10.1016/j.jelectrocard.2010.10.034 Get rights and content

Abstract

Aim

The aim of this study was to identify factors associated with prolonged QT interval in liver cirrhosis patients.

Materials and Methods

Thirty-eight patients with liver cirrhosis were enrolled in this study. The maximal QT interval (QTmax), heart rate–corrected QT interval (QTc), QT interval in lead DII (QTII), and mean QT interval (QTm) were determined manually, using 12-lead electrocardiogram. Additional laboratory tests were also performed.

Results

The following values were obtained: QTmax, 435 ± 43 milliseconds; QTc, 493 ± 46 milliseconds; QT interval in lead DII, 405 ± 46 milliseconds; and mean QT interval, 400 ± 40 milliseconds. Ten (6%) patients had a prolonged QTmax, and 27 (71%) had a prolonged QTc. The highest values were obtained for QTc and QTmax in patients with alcoholic cirrhosis and Child-Pugh class C, respectively. A moderate correlation was observed between QTmax and serum uric acid (URCA; r = 0.504), and multiple linear regression analysis revealed that URCA was significantly associated with QTc and heart rate.

Conclusions

Liver disease severity, alcoholic etiology, and URCA are associated with prolonged QT interval in patients with liver cirrhosis.

Introduction

A prolonged QT interval represents the most common electrocardiographic (ECG) finding in patients with liver cirrhosis¹ and is part of the “cirrhotic cardiomyopathy.” Cirrhotic cardiomyopathy, a recently recognized condition, includes systolic incompetence, diastolic dysfunction related to altered diastolic relaxation, and electrophysiologic abnormalities in the absence of any known cardiac disease; it can be identified in all forms of cirrhosis.² The aim of this study was to identify factors associated with QT interval prolongation in patients with liver cirrhosis.

Section snippets

Patients

Thirty-eight consecutive patients with liver cirrhosis admitted to the Fourth Medical Clinic from Timisoara were enrolled in the study. The average patient age was 58 ± 12 years, and 50% were men. Liver cirrhosis of any etiology was the primary inclusion criterion and was diagnosed according to the presence of 2 or more of the following characteristics: esophageal or gastric varices confirmed by endoscopy, ascites confirmed by ultrasonography, or increased international normalized ratio that

Results

The QT parameters and laboratory results are included in Table 1. HR was 77 ± 15 beats/min. The 95% confidence interval for QTmax is 339.7 to 511.35 milliseconds, with a standard error of 6.96. A QTmax of 450 milliseconds or more was present in 26% (10) of the patients, and 71% (27) of the patients had a prolonged QTc. The highest values were obtained for QTmax, QTc, and QTm in patients with alcoholic cirrhosis and Child-Pugh class C (Table 2, Table 3). HR–corrected QT interval was

Discussion

The most important finding in this study is that prolonged QT intervals (QTmax and QTc) in patients with liver cirrhosis are significantly related to increased URCA levels. To our knowledge, this represents a novel finding that has not been previously reported.

Several authors have demonstrated a prolonged QT interval, especially in patients with alcoholic liver cirrhosis and Child-Pugh class C.1, 2, 3, 4, 6 Genovesi et al¹ studied QT interval length in 48 male cirrhosis patients and identified

Conclusion

The severity of liver disease, alcoholic etiology, and URCA are all associated with QT interval prolongation in patients with liver cirrhosis. QT-prolonging drugs should be avoided in patients with liver cirrhosis.

Acknowledgments

The authors thank Laney Weber, PhD, for the critical reading of the manuscript.

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Factors associated with a prolonged QT interval in liver cirrhosis patients

Abstract

Aim

Materials and Methods

Results

Conclusions

Introduction

Section snippets

Patients

Results

Discussion

Conclusion

Acknowledgments

Best Pract Res Clin Gastroenterol

J Am Coll Cardiol

J Hepatol

Metabolism

Nutrition

Nutr Metab Cardiovasc Dis

QT interval prolongation and decreased heart rate variability in cirrhotic patients: relevance of hepatic venous pressure gradient and serum calcium

Clin Sci