Alterations in Corrected QT Interval Following Liver Transplant in Patients With End‐Stage Liver Disease

Zurick, Andrew O.; Spier, Bret J.; Teelin, Thomas; Lorenze, Katelin R.; Alberte, Cesar; Zacks, Steven; Lindstrom, Mary J.; Pfau, Patrick R.; Selzman, Kimberly A.

doi:10.1002/clc.20801

Cited by 19 publications

(21 citation statements)

References 47 publications

(38 reference statements)

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“…Although QTc prolongation is common in patients with ESLD, it often resolves after transplantation (93,94). In a retrospective cohort, nearly one-half of 600 ESLD patients studied had a QTc Ͼ440 ms pre-operatively, with resolution in approximately one-half of these patients after transplantation.…”

Section: Qt Interval Prolongationmentioning

confidence: 98%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

228

174

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Liver transplantation (LT) candidates today are increasingly older, have greater medical acuity, and have more cardiovascular comorbidities than ever before. Steadily rising model for end-stage liver disease (MELD) scores at the time of transplant, resulting from high organ demand, reflect the escalating risk profiles of LT candidates. In addition to advanced age and the presence of comorbidities, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Patients with cirrhosis requiring LT usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These cardiac disturbances are likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators with cardiodepressant properties, and repolarization changes. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. These physiologic changes all contribute to the potential for cardiovascular complications, particularly with the altered hemodynamic stresses that LT patients face in the immediate post-operative period. Post-transplant reperfusion may result in cardiac death due to a multitude of causes, including arrhythmia, acute heart failure, and myocardial infarction. Recognizing the hemodynamic challenges encountered by LT patients in the perioperative period and how these responses can be exacerbated by underlying cardiac pathology is critical in developing recommendations for the pre-operative risk assessment and management of these patients. The following provides a review of the cardiovascular challenges in LT candidates, as well as evidence-based recommendations for their evaluation and management.

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Section: Qt Interval Prolongationmentioning

confidence: 98%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

228

174

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“…Five studies assessing post-transplant outcomes did not show impact of prolonged QTc on post-transplant survival. (4,5,7,9,10) However, Sonny et al (11) showed that composite outcomes denoted by mortality, graft failure, and/or major cardiovascular events (CVEs) were associated with prolonged QTc pretransplant during a mean follow-up of 5 years post-transplant. Major CVEs were defined as the presence of coronary artery disease requiring intervention, congestive heart failure (HF), or ischemic stroke.…”

Section: Impact Of Qtc Changes On Post-transplant Coursementioning

confidence: 99%

Cirrhotic Cardiomyopathy After Transplantation: Neither the Transient Nor Innocent Bystander

Izzy

Watt

2018

Hepatology

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Cirrhotic cardiomyopathy in end-stage liver disease is currently characterized by blunted contractile systolic response to stress with or without diastolic dysfunction in the absence of known heart disease. Since the establishment of the diagnostic criteria of cirrhotic cardiomyopathy in 2005, there have been multiple studies regarding its pathophysiology and pretransplant clinical course. The data regarding the post-transplant course of this entity are sparse. This review addresses the course and prognosis of the elements of cirrhotic cardiomyopathy after liver transplantation (LT). To this end, there is limited compelling evidence demonstrating the reversibility of this entity post-LT. Cirrhotic cardiomyopathy may, in fact, increase the risk of post-transplant complications. This review reveals a need to refine the diagnostic criteria of cirrhotic cardiomyopathy in view of the remarkable progress in the sphere of echocardiographic evaluation of systolic and diastolic dysfunction. The post-transplant course and outcomes related to cirrhotic cardiomyopathy may be better evaluated in the setting of updated diagnostic criteria.

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“…This was attributed to vagal reactivation post-exercise which was similar vs. baseline, especially in the time domain RMSSD and SDNN and in frequency domain HFnu, considered parameters of parasympathetic modulation [33]. Previous studies reported electrophysiological abnormalities with repolarization change in patients with liver cirrhosis, attributed to alterations in the potassium channels, worsening with the disease condition [8,38]. Alterations in the cardiovascular function with hyperdynamic circulation, reduced systolic contraction and diastolic relaxation can increase the sympathetic modulation in order to maintain the cardiac output in these patients [31,36].…”

Section: Discussionmentioning

confidence: 99%

Effect of Different Circuit Training on Cardiovascular Responses in Cirrhotic Patients

et al. 2018

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The purpose of this study was to analyze and compare heart rate (HR), heart rate variability (HRV), and blood pressure (BP) responses during and after circuit resistance training with 1 min. (CIR1) vs. 2 min. (CIR2) rest intervals between exercises in liver cirrhosis patients. 10 patients (7 women, 3 men) participated in 2 experimental sessions (CIR1 and CIR2) in random order. Each experimental session consisted of 6 exercises performed for 3 sets of 10 repetitions with 70% of the 10-RM load. The only difference between experimental sessions was taking either 1 min. (CIR1) or 2 min. (CIR2) of rest between exercises. Prior and during each session, BP, HR and HRV (beat-to-beat intervals) were assessed. Training efficiency were significant higher for CIR1 when compared to CIR2, since same total training volume was performed in less time. Both protocols elicited significant changes in HR, SBP, and SampEn. Based on the ∆HR and ∆IRR between protocols, higher cardiovascular stress was observed for CIR1 vs. CIR2. However, the patients presented a similar recovery pattern between experimental sessions, and did not present significant alterations in the HRV at 60 min post-workout. In summary, the fast adjustment of autonomic modulation in HRV and BP suggests that circuit resistance training with 1-min or 2-min rest intervals between exercises elicits typical cardiovascular responses in liver cirrhosis patients.

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Alterations in Corrected QT Interval Following Liver Transplant in Patients With End‐Stage Liver Disease

Cited by 19 publications

References 47 publications

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Cirrhotic Cardiomyopathy After Transplantation: Neither the Transient Nor Innocent Bystander

Effect of Different Circuit Training on Cardiovascular Responses in Cirrhotic Patients

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