Evaluation of QTC Interval in Cirrhosis Patients with Variceal Hemorrhage (original) (raw)
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Prolongation of the QTc interval in patients with cirrhosis
ANNALS OF GASTROENTEROLOGY, 2003
QT interval prolongation predicts severe ventricular arrhythmias and sudden death. The aim of this work was to confirm the prevalence of QT interval prolongation in patients with liver cirrhosis due to alcoholism and chronic hepatitis B or C and define its association with the severity of the disease. Fifty-two patients with cirrhosis (29 due to alcohol abuse and 23 due to chronic hepatitis B or C) were enrolled. In all patients QT interval corrected (QTc) for ventricular heart rate was assessed along with Child-Pugh score. QTc was found prolonged in both groups of patients with alcoholic and postviral cirrhosis (0,471 sec, P=0,0007 and 0,461 sec, P=0,0017 respectively) with no difference between the two groups (P=0,3142). Prolongation of the QTc interval was statistically confirmed in Child-Pugh C and B groups (0,489 sec, P=0,0019 and 0,480 sec, P=0,0002 respectively) but not in Child-Pugh A group (0,445 sec, P=0,4366). These data show that QTc interval prolongation in cirrhotic patients refers to Child-Pugh B and C but is independent from the etiology of cirrhosis.
Correlation of Prolonged QT Interval and Severity of Cirrhosis of Liver
Annals of King Edward Medical University, 2011
Objective: To determine correlation between prolon-ged QT interval and severity of disease in patients of cirrhosis of liver. Place of Study: Department of Medicine, King Ed-ward Medical University. Duration of Study: March 2008 to May 2010. Study Design: Descriptive cross sectional study. Patients and Methods: One hundred and seventeen patients of cirrhosis were included. Baseline haemato-logical and biochemical parameters were determined. Model for end stage liver disease (MELD) score was determined for all patients to document stage of liver disease. Corrected QT interval was determined from electrocardiography of each patient using QT cirrhosis formula. Correlation between QT interval and MELD score was determined using Pearson correlation and Receiver Operating Characteristic (ROC) curve. Results: One hundred and seventeen included patients had mean age of 53.58 (± 12.11) while male to female ratio was 1.78/1 (75 / 42). Mean MELD score was 17.08 (± 6.54) in study patien...
Q-T interval prolongation in cirrhosis: Relationship and severity
Caspian Journal of Internal Medicine, 2018
Background: Cirrhosis as the final stage of progressive fibrosis of liver can affect other organs such as lungs, kidneys and heart. "Cirrhotic cardiomyopathy" involves the electrophysiological abnormalities such as QT interval prolongation. We assessed correlation between corrected QT interval prolongation and severity of cirrhosis based on Child Classification in each ECG lead. Methods: In this case-control study, the patients attending the outpatient clinic and inpatient department of internal medicine of Velayat Hospital in Qazvin were enrolled from September 2014 to July 2015. Total samples were 74 patients, half of which were used as controls. Cirrhosis severity was determined as per Child Classification. Both groups had Ca 2+ , Mg 2+ , K + tested and 12-lead ECG was obtained. The QT interval was corrected by two different formulas: (1) QTc=QT/√RR (QTc 1); (2) QTc=QT+1.75 (heart rate-60) (QTc 2). To analyze the data, the software SPSS Version 16 and Mann-Whitney, Pearson's chisquare test-Kruskal-Wallis, and t-tests were used. Results: The mean of QTc 1 and QTc 2 was longer in cirrhotics than the control group. There was a significant correlation between Child score and length of QTc 1 in leads: III (p=0.032), AVL (p=0.041), V2 (p=0.049), V6 (p=0.015). There were significant differences in length of QTc 1 in leads: V3 (p=0.031) and V6 (p=0.021); and QTc 2 in lead V3 (p=0.039) between Child Classification. Conclusions: Cirrhosis can induce QTc interval prolongation. Lead V3 has statistically significant correlation with the severity of cirrhosis based on child classification. We propose that QT interval prolongation be added as a criterion for prioritizing liver transplantation.
Hepatology, 1998
Prolonged Q-T interval predicts severe arrhythmias and sudden death, and has been shown to occur in alcoholic liver disease and cirrhotic patients who are candidates for liver transplantation. This study first evaluated the prevalence of prolonged Q-T interval in a large population of unselected patients with cirrhosis, and assessed the relationship between abnormal Q-T, etiology, and severity of liver disease and mortality of patients. Possible causes of Q-T abnormality were also explored. Ninety-four patients with cirrhosis without overt heart disease and 37 control subjects with mild chronic active hepatitis were enrolled. Rate-corrected Q-T interval (Q-T c ) was assessed along with routine liver tests, Child-Pugh score, serum bile salts, electrolytes and creatinine, plasma renin activity, aldosterone, norepinephrine, atrial natriuretic factor and, gonadal hormones. Q-T c was longer in patients with cirrhosis than in controls (440.3 ؎ 3.2 vs. 393.6 ؎ 3.7 ms; P F .001) and prolonged (G440 ms) in 44 patients (46.8%) and 2 controls (5.4%; P F .001). Q-T c length was not influenced by the etiology of cirrhosis and correlated with Child-Pugh score (r ؍ .53; P F .001), liver tests such as prothrombin activity, and serum concentrations of albumin and bilirubin, plasma bile salts, and plasma norepinephrine. Multivariate analysis showed that only Child-Pugh score and plasma norepinephrine were independently correlated with Q-T c duration. Over a median follow-up period of 19 months (range, 2-33 months), patients with Q-T c longer than 440 ms had a significantly lower survival rate than those with normal Q-T c . Q-T interval is frequently prolonged in patients with cirrhosis, regardless the etiology of the disease, worsens in parallel with the severity of the disease, and may have an important prognostic meaning. In addition to other unde-fined factors related to the severity of cirrhosis, sympathoadrenergic hyperactivity may play a pathogenetic role. (HEPA-TOLOGY 1998;27:28-34.)
Journal of family medicine and primary care, 2020
Introduction: Cirrhotic cardiomyopathy is characterised by increased baseline cardiac output, systolic and diastolic dysfunction, diminished cardiovascular response to stressful stimuli and electrophysiological abnormalities in patients of cirrhosis in the absence of any underlying cardiac disease. QTc prolongation has been described as a common electrocardiographic abnormality in cirrhosis patients. Aims and Objectives: This study was done to evaluate the prevalence of QTc changes in patients of cirrhosis coming to a rural tertiary care centre and to analyse its correlation with disease severity. Materials and Methods: The present study was conducted on 100 patients suffering from cirrhosis of liver presented to the department of medicine. Around 100 age and sex-matched individuals were recruited as controls. The Child-Pugh score was used to determine the disease severity in cirrhosis patients. Standard 12-lead ECG was recorded in all cases and controls. Results: Prolongation of QTc interval on ECG was observed in the majority (80%) of cirrhosis patients and it was significantly higher as compared to the healthy controls (P <0.01). The prolongation of QTc was significantly associated with the duration of disease (P <0.05) and disease severity as measured by the Child-Pugh score (P <0.01). Conclusion: QTc prolongation on ECG may be an early marker of cardiac involvement in patients of cirrhosis and is significantly associated with disease severity.
Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 2016
Arrhythmias and electrocardiographic changes are reported in several noncardiac diseases, including liver cirrhosis (LC). We intended to evaluate the interval from the peak to the end of the electrocardiographic T wave (Tp-e), Tp-e/QTc ratio, and fQRS as presumed markers of arrhythmias in LC. In this cross-sectional study, a total of 88 consecutive patients with LC according to clinical, biological, ultrasonographic, or histological criteria and 73 control subjects were enrolled. The severity of cirrhosis was classified according to Pugh-Child's classification and Model for End-Stage Liver Disease (MELD) score. Tp-e interval, Tp-e/QTc ratio, and fQRS rates were measured from the 12-lead electrocardiogram. Tp-e interval, Tp-e/QTc ratio and fQRS rates were significantly increased in parallel to the severity of LC (P < 0.001, P < 0.001, and P = 0.003, respectively). In correlation analysis, Pugh-Child stage showed a significantly positive correlation with Tp-e interval (r = 0...
Q-T Interval Prolongation in Patients with Liver Cirrhosis
Current Health Sciences Journal, 2018
Liver cirrhosis (LC) is the end stage of chronic liver disease characterized by the appearance of extensive fibrosis and regeneration nodes associated with hepatocyte necrosis in liver but also by the reshuffling of hepatic architecture. The triad consisting of hepatic parenchymal necrosis, regeneration and scarring is always present regardless of the type of clinical manifestation. The Child-Pugh-Turcotte classification dates back more than 30 years and has been widely used in diagnosing and assessing the severity of liver cirrhosis. This is preferred due to a low degree of complexity and a good predictive value. Prolongation of the QT interval on the electrocardiogram is common, with a prevalence exceeding 60% in patients with advanced stage of cirrhosis. In these cases, beta blockers and antiarrhythmics should be avoided or used with caution and with close QT interval monitoring. Changes in heart rate and Q-T interval are new entities in cirrhosis complications. A prolonged Q-T i...
Factors associated with a prolonged QT interval in liver cirrhosis patients
Journal of Electrocardiology, 2011
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.
Digestive Diseases and Sciences, 2019
Background Acute variceal bleeding (AVB) in patients with cirrhosis is associated with high mortality, ranging from 12 to 20% at 6 weeks. The existing prognostic models for AVB lack precision and require further validation. Aim In this prospective study, we aimed to develop and validate a new prognostic model for AVB, and compared it with the existing models. Methods We included 285 patients from March 2017 to November 2017 in the derivation cohort and 238 patients from December 2017 to June 2018 in the validation cohort. Two prognostic models were developed from derivation cohort by logistic regression analysis. Discrimination was assessed using area under the receiver operator characteristic curve (AUROC). Results The 6-week mortality was 22.1% in derivation cohort and 22.3% in validation cohort, P = 0.866. Model for end-stage liver disease (MELD) [odds ratio (OR) 1.106] and encephalopathy (E) (OR 4.658) in one analysis and Child-Pugh score (OR 1.379) and serum creatinine (OR 1.474) in another analysis were significantly associated with 6-week mortality. MELD-E model (AUROC 0.792) was superior to Child-creatinine model (AUROC) in terms of discrimination. The MELD-E model had highest AUROC; as compared to other models-MELD score (AUROC 0.751, P = 0.036), Child-Pugh score (AUROC 0.737, P = 0.037), D'Amico model (AUROC 0.716, P = 0.014) and Augustin model (AUROC 0.739, P = 0.018) in derivation cohort. In validation cohort, the discriminatory performance of MELD-E model (AUROC 0.805) was higher as compared to other models including MELD score (AUROC 0.771, P = 0.048), Child-Pugh score (AUROC 0.746, P = 0.011), Augustin model (AUROC 0.753, P = 0.039) and D'Amico model (AUROC 0.736, P = 0.021). Conclusion In cirrhotic patients with AVB, the novel MELD-Encephalopathy model predicts 6 weeks mortality with higher accuracy than the existing prognostic models.