Prolonged QTc Interval Is an Electrophysiological Hallmark of Cirrhotic Cardiomyopathy

Abstract

BACKGROUND: Cirrhotic Cardiomyopathy is a relatively ill-characterized condition, which is often under-diagnosed due to absence of defined diagnostic criteria. ECG showing corrected QT Interval prolongation is the most suitable available option for diagnosis of this condition. OBJECTIVE: To determine the frequency of corrected QT interval prolongation in patients with liver cirrhosis. METHODOLOGY: Patients (n = 166) with confirmed cirrhosis, 30 years or older, presented in the outpatient and emergency department of medicine at Capital Hospital Islamabad between 1 October 2011 and 30 September 2012, were enrolled in this cross-sectional study after taking consent. ECG was done using calibrated ECG machine, and the QT Interval was measured. Corrected QT was calculated using Bazett's formula and a QTc of more than 0.44 seconds was considered as being prolonged. RESULTS: The mean age of the patients was 57.05 ± 12.03 years. The corrected QT Interval varied from 337 ms to 560 ms. The mean QTc Interval was 429.92 ms ± 45.11. QTc was prolonged in 41 out of 166 patients (24.7%). Frequency of QTc prolongation was 4.5% in Child Pugh Grade A, 23.2% in Child Pugh Grade B, and 32.0% in Child Pugh Grade C. Association of Child Pugh Scoring with QTc prolongation was determined and found to be statistically significant (P < 0.05). CONCLUSION: QTc interval was prolonged in 24.7% of cirrhotic patients in our study. There was a significant increase in frequency with worsening of Child Pugh Grade, thereby indicating an association between QTc prolongation and the severity of cirrhosis.

Characteristics of Cirrhosis Patients With Left Ventricular Diastolic Dysfunction In China: A Single-Center Retrospective Study.

“…This is close to the results presented by Bernardi et al 27 . However, Zuberi et al 28 and Bhatti et al 3 found the frequency of QTc prolongation was much lower than us. This discrepancy may be explained by the presence of other compounding factors such as electrolyte disturbances, concomitant cardiac problems, or use of QTc prolonging drugs, which were excluded in our study but might have been included in other studies.…”

Cardiac Profile of Filipino Patients With Liver Cirrhosis: A 10-Year Study

“…Compared to our cohort which only had 15 patients (11%) classified as CPC C, there were more cases of CPC C in the study of Kumar et al (49%, 36) and Bhatti et al (45%, 77) which are reflective of a more decompensated state [12, 13]. Most of our patients were classified as CPC A (20%, 17) and CPC B (68%, 57) which have better prognosis.…”

“…Prolonged QTc interval has been reported to be an electrophysiological hallmark of cirrhotic cardiomyopathy [13]. Although studies have reported a correlation of the prolongation of the QT interval to the severity of liver cirrhosis, our patients were observed to have prolonged QT interval in the early stages of liver cirrhosis (CPC A or MELD score of 9 or below) and in the late stage of cirrhosis (CPC C).…”

“…The mean age of our patients was 72.4 ± 14 years with a slight female preponderance. This is significantly higher compared to studies done in other countries which reported lower mean ages [12, 13]. Kumar et al [12] studied 90 patients with liver cirrhosis and reported a lower mean age of 46.2 ± 10.8 years and a male predominance (78%).…”

“…Kumar et al [12] studied 90 patients with liver cirrhosis and reported a lower mean age of 46.2 ± 10.8 years and a male predominance (78%). Bhatti et al [13] reported a mean age of 57.05 ± 12.03 years and a male predominance (58%) in his cohort of 166 patients. The authors believed that this was related to the age of onset of the inciting factor that lead to the development of cirrhosis.…”