QT Interval Analysis in Patients With Chronic Liver Disease: A Prospective Study

Koşar, Feridun; Ateş, Fehmi; Şahin, İ̇brahim; Karıncaoğlu, Melih; Yıldırım, Bülent

doi:10.1177/0003319707300368

Cited by 32 publications

(35 citation statements)

References 26 publications

(52 reference statements)

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“…Whereas these findings with regard to QTc are confirmatory of previous data (12,13), our findings of a longer QTmax, QTmin, QTdisp and TpTe could appear original, owing to the fact that, to our knowledge, no study has addressed the whole spectrum of electrocardiographic markers of ventricular repolarization in cirrhotic patients. It has been suggested that the prolongation of the QT interval in cirrhotic patients is associated with a greater severity of liver disease.…”

Section: Discussionsupporting

confidence: 89%

“…A study conducted in subjects with alcoholic cirrhosis showed a higher incidence of sudden death in subjects with longer QT interval (12). Other studies showed a higher risk of sudden cardiac death in subjects with cirrhosis in treatment with drugs potentially linked to lengthening of QT interval (25e27).…”

Section: Discussionmentioning

confidence: 98%

“…Another study (12) evaluated in 33 consecutive patients with cirrhosis and 35 sex-and age-matched healthy subjects QT intervals and QT dispersion indexes after correction for heart rate according to Bazett's formula. Authors analyzed ARCMED2004_proof ■ 2-4-2015 7-59-11 QTmax, QT interval; QT min, QT minimum; QTc, QT corrected; TpTe, T peak-to-end; QTdisp, QT interval dispersion.…”

Section: Discussionmentioning

confidence: 99%

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QT Indexes in Cirrhotic Patients: Relationship with Clinical Variables and Potential Diagnostic Predictive Value

Tuttolomondo

Buttà

Casuccio

et al. 2015

Archives of Medical Research

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Background and Aims. A wide spectrum of cardiovascular changes characterizes cirrhosis, ranging from subclinical alterations to hyperkinetic syndrome. We looked for ECG markers of ventricular repolarization in a population of patients with cirrhosis in comparison to patients without cirrhosis and we investigated the relationship between these and other clinical and laboratory variables. Methods. In 149 patients with cirrhosis and 152 controls, we measured QT maximum interval (QTmax), QT corrected interval (QTc), QT minimum interval (QTmin), QT dispersion (QTdisp), QT peak and T peak-to-end (TpTe).Results. In subjects with cirrhosis, in comparison with controls, we observed a higher mean QTmax, mean QTc, mean QTmin, mean QTdisp and mean TpTe. At Cox regression analysis, diastolic blood pressure and beta-blocker treatment were significantly associated with mean QTmax, hypertension with mean QTmin and mean QTc, diastolic blood pressure, beta-blockers and ACE-inhibitors/ARBs with QT disp, and beta-blockers with TpTe. Analysis of ROC curves showed a significant area under curve towards cirrhosis diagnosis, respectively, for a cut-off value of O400 msec of QTmax, O360 msec of QTmin, O450 msec of QTc, O105 msec of TpTe and O55 msec of QTdisp. Conclusions. Our study shows that QT indexes are altered in cirrhotic patients and have a potential diagnostic predictive value. Ó 2015 IMSS. Published by Elsevier Inc.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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QT Indexes in Cirrhotic Patients: Relationship with Clinical Variables and Potential Diagnostic Predictive Value

Tuttolomondo

Buttà

Casuccio

et al. 2015

Archives of Medical Research

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“…Over the last 2 decades, there is accumulating evidence to suggest that the presence of cirrhosis per se is associated with significant cardiovascular abnormalities, irrespective of the cause of cirrhosis. These include resting increased cardiac output; decreased systemic vascular resistance [1]; reduced myocardial contractility or systolic incompetence, especially under conditions of stress, whether physiological [5], physical [6,7], or pharmacological [8]; increased thickness of the left ventricle [9][10][11], associated with diastolic dysfunction; and electrophysiological abnormalities [12][13][14]. This constellation of abnormalities has been termed cirrhotic cardiomyopathy [15].…”

Section: Introductionmentioning

confidence: 99%

Cirrhotic cardiomyopathy

2008

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Cirrhotic cardiomyopathy is a recently recognized condition in cirrhosis consisting of systolic incompetence under condition of stress, diastolic dysfunction related to altered diastolic relaxation, and electrophysiological abnormalities in the absence of any known cardiac disease. It can be diagnosed by using a combination of electrocardiograph, 2-dimensional echocardiography, and various serum markers such as brain natriuretic factor. The underlying pathogenetic mechanisms include abnormalities in the b-adrenergic signaling pathway, altered cardiomyocyte membrane fluidity, increased myocardial fibrosis, cardiomyocyte hypertrophy, and ion channel defects. Various compounds for which levels are elevated in cirrhosis such as nitric oxide and carbon monoxide can also exert a negative inotropic effect on the myocardium, whereas excess sodium and volume retention can lead to myocardial hypertrophy. Various toxins can also aggravate the ion channel defects, thereby widening the QRS complex causing prolonged QT intervals. Clinically, systolic incompetence is most evident when cirrhotic patients are placed under stress, whether physical or pharmacological, or when the extent of peripheral arterial vasodilatation demands an increased cardiac output as in the case of bacterial infections. Acute volume overload such as immediately after insertion of a transjugular intrahepatic portosystemic shunt or after liver transplantation can also tip these cirrhotic patients into cardiac failure. Treatment of cirrhotic cardiomyopathy is unsatisfactory. There is some evidence that b-blockade may help some cirrhotic patients with baseline prolonged QT interval. Long-term aldosterone antagonism may help reduce myocardial hypertrophy. Future studies should include further elucidation of pathogenetic mechanisms so as to develop effective treatment strategies.

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“…A recent study has demonstrated an alteration related to ventricular repolarization, such as QT and QTc intervals, in pregnant women with preeclampsia (15). Furthermore, many studies have reported a clinical utility of QT d as a prognostic factor for mortality in several diseases (16,17).…”

Section: Introductionmentioning

confidence: 99%

P-Wave and QT Dispersion in Pregnant Women with Preeclampsia

Çakmak¹,

Çakmak²,

Özgen³

et al. 2016

JAREM

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Objective: Preeclampsia is an important cause of maternal and fetal mortality and morbidity worldwide. P-wave dispersion (P d ) and QT interval dispersion (QT d ) are direct measures of the nonhomogenity of atrial depolarization and ventricular repolarization, respectively, in electrocardiography (ECG). Recent studies have reported a significant role of prolonged P d and QT d in various cardiovascular diseases. Because the effect of acute pressure overload, which occurs in a preeclamptic setting, on the intra-and/or interatrial and ventricular conduction times remains unknown, we aimed to investigate the relation of P d and QT d with the presence and severity of preeclampsia.Methods: Forty-eight consecutive pregnant women with preeclampsia and 55 healthy, age-matched pregnant women were included in this retrospective study between January and September 2015. The pregnant women with preeclampsia were divided into two groups according to disease severity as follows: mild and severe preeclampsia. A 12-lead ECG was performed for all the pregnant women before cesarean section operation.Results: Compared with the healthy pregnant women, P d and QT d were significantly prolonged in patients with preeclampsia. Moreover, in the subgroups of preeclampsia, P d was significantly increased in the severe group. P d and QT d were directly related to systolic and diastolic blood pressure, which are well-known validated indicators for the severity of preeclampsia. Conclusion:Preeclampsia triggers an alteration of atrial depolarization and ventricular repolarization, which are evidenced by the prolongation of ECG parameters such as P d and QT d . ECG is a noninvasive, easy to use, and easily available diagnostic tool, which can be used in the assessment of atrial and ventricular electrical activity in pregnant women with preeclampsia.

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QT Interval Analysis in Patients With Chronic Liver Disease: A Prospective Study

Cited by 32 publications

References 26 publications

QT Indexes in Cirrhotic Patients: Relationship with Clinical Variables and Potential Diagnostic Predictive Value

QT Indexes in Cirrhotic Patients: Relationship with Clinical Variables and Potential Diagnostic Predictive Value

Cirrhotic cardiomyopathy

P-Wave and QT Dispersion in Pregnant Women with Preeclampsia

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