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

Genovesi, Simonetta; Pizzala, Daniela Prata; Pozzi, Massimo; Ratti, Laura; Milanese, M.; Pieruzzi, Federico; Vincenti, Antonio; Stella, Andréa; Mancia, Giuseppe; Stramba-Badiale, Marco

doi:10.1042/cs20080325

Cited by 93 publications

(87 citation statements)

References 40 publications

(53 reference statements)

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“…The highest values of QT and QTc intervals were observed in class C (Child-Pugh) [4,[13][14][15][16]. Mozos et al confirmed these observations in a study involving 38 patients with cirrhosis; additionally they demonstrated a correlation with alcoholic cirrhosis etiology and the level serum uric acid [17].…”

Section: Discussionsupporting

confidence: 72%

“…Another study carried out on a Greek population revealed a correlation between the QT interval and the severity of cirrhosis, but not between the QT interval and cirrhosis etiology [18]. Genovesi et al demonstrated a significant correlation between the stage of cirrhosis according to the Child-Pugh classification, the hepatic venous pressure gradient (HVPG) and QT interval prolongation, which was more common in patients with alcoholic than viral cirrhosis [13]. QT interval prolongation independently predicts bleedinginduced mortality in patients with cirrhosis [19].…”

Section: Discussionmentioning

confidence: 99%

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QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

Cichoż‐Lach¹,

Tomaszewski²,

Kowalik³

et al. 2015

Adv Clin Exp Med

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Background. Liver cirrhosis is associated with functional abnormalities of the cardiovascular system with coexisting electrocardiographic (ECG) abnormalities. Objectives.The aim was to analyze ECG changes in patients with cirrhosis, to evaluate whether alcoholic etiology of cirrhosis and ascites has an impact on ECG changes. Material and Methods. The study involved 81 patients with previously untreated alcoholic cirrhosis (64 patients with ascites, classes B and C according to the Child-Pugh classification; and 17 without ascites, categorized as class A); 41 patients with previously untreated cirrhosis due to chronic hepatitis C (HCV -30 patients with ascites, classes B and C; and 11 without ascites, class A); 42 with alcoholic steatohepatitis and 46 with alcoholic steatosis. The control group consisted of 32 healthy volunteers. Twelve-lead ECG recordings were performed and selected parameters were measured. Results. Significantly longer QT and QTc intervals and lower QRS voltage were found in patients with alcoholic and HCV cirrhosis compared to the controls. Significantly lower QRS voltage was found in subjects with ascites than in those without ascites. Removal of ascites significantly increased QRS voltage. Conclusions. In cirrhosis, irrespective of etiology, ECG changes involved prolonged QT and QTc intervals and reduced QRS voltage. Prolonged QT and QTc intervals were not related to the severity of cirrhosis or to the presence of ascites. However, low QRS voltage was associated with the presence of ascites. Removal of ascites reverses low QRS voltage (Adv Clin Exp Med 2015, 24, 4, 615-622).

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

Cichoż‐Lach¹,

Tomaszewski²,

Kowalik³

et al. 2015

Adv Clin Exp Med

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“…In a study by Bal and Thuluvath (15), a prolonged QTc was seen more commonly in patients with alcoholic cirrhosis (60%) compared to non-alcoholic cirrhosis (35%), and alcoholic cirrhosis was one of the independent predictors of QT interval prolongation. A study by Genovesi et al (16) suggests that the alcoholic etiology may indeed play a role in the prolongation of QT interval in cirrhotic patients, although the relatively small size of the population does not allow a precise definition of its contribution.…”

Section: Discussionmentioning

confidence: 99%

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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“…A number of studies (5,6,10,16) assessed the slope of the QT/RR relationship in long-term Holter recordings and investigated its meaning as a clinical characteristic. The majority of these studies investigated the relationship by means of linear regression between simultaneously measured QT and RR intervals; only infrequently was the linear regression applied to logarithmically transformed QT and RR data.…”

mentioning

confidence: 99%

“…Since the design of accurate individual QT rate corrections depends on accurate mathematical description of baseline QT/RR relationship (9), it has been proposed to fit different nonlinear models to the data of different individuals, which, in essence, means to classify the curvatures of the QT/RR patterns into several distinct categories (10,12). While this technology has been used successfully in studies of electrocardiographic drug effects (24, 25), it does not deal with the problem of the QT/RR curvature fully (26).…”

mentioning

confidence: 99%

QT/RR curvatures in healthy subjects: sex differences and covariates

Malik

Hnatkova²,

Kowalski

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Data of a large clinical study were used to investigate how much are the QT/RR patterns in healthy subjects curved and whether these curvatures differ between women and men. Daytime drug-free 12-lead Holter recordings were repeated 4 times in each of 176 female healthy subjects and 176 male healthy subjects aged 32.7 Ϯ 9.1 yr. In each of the subjects, up to 1,440 carefully verified QT interval measurements were obtained with QT/RR hysteresis-corrected RR intervals. Individual subject data were used to fit the following regression equation: QT ϭ ϩ (␦/␥)(1 Ϫ RR ␥ ) ϩ ε, where QT and RR are QT and RR measurements (in s), is regression intercept, ␦ is the QT/RR slope, ␥ is the QT/RR curvature and provides the lowest regression residual, and ε represents normally distributed zero-centered errors. The bootstrap technique showed the intrasubject reproducibility of QT/RR slopes and curvatures. In women and men, QT/RR curvatures were 0.544 Ϯ 0.661 and 0.797 Ϯ 0.706, respectively (P ϭ 0.0006). The corresponding QT/RR slopes were 0.158 Ϯ 0.030 and 0.139 Ϯ 0.023, respectively (P Ͻ 0.0001). QT/RR curvatures were related to QT/RR slopes but not to individually corrected mean QTc intervals or individual QT/RR hysteresis profiles. The individual heart rate correction formula derived from the curvilinear regression provided a significantly lower intrasubject variability of QTc interval than individual optimisation of linear or log-linear QT/RR heart rate corrections. The QT/RR curvature can be reliable measured and expressed numerically. The corresponding heart rate correction formula provides more compact data than the previously proposed approaches. There are substantial sex differences in QT/RR patterns. Women have a QT/RR pattern that is not only steeper than men but also more curved.QT/RR curvature profile; intrasubject stability; intersubject differences; QT heart rate correction THE DEPENDENCY of the duration of ventricular repolarization on the underlying heart rate is well known. It is also known that it is related to a similar dependency of action potential durations (7) that shows regional differences within the ventricular myocardium (23). Similarly, delayed adaptation of action potential durations after abrupt changes in stimulation rates are well known (8). The intracellular mechanism underlying the repolarization dependency and thus the pattern of the QT/RR relationship are not completely understood and have been subject of both animal and modeling experiments of ionic currents (11,19,22). Why the QT/RR relationship and adaptation exhibits substantial intersubject differences with intrasubject stability (3, 27) is not known. Further studies of the phenomenon require appropriate tools for the description of the relationship.A number of studies (5, 6, 10, 16) assessed the slope of the QT/RR relationship in long-term Holter recordings and investigated its meaning as a clinical characteristic. The majority of these studies investigated the relationship by means of linear regression between simultaneously measured QT a...

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

Cited by 93 publications

References 40 publications

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

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

QT/RR curvatures in healthy subjects: sex differences and covariates

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