Autonomic Regulation of Heart Rate and QT Interval in Nonalcoholic Cirrhosis with Ascites

Lazzeri, Chiara; Villa, Giorgio La; Vecchiarino, Sabrina; Gambilonghi, Francesco; Geñtilini, Paolo; Franchi, F

doi:10.1159/000201505

Cited by 39 publications

(50 citation statements)

References 18 publications

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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: 90%

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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: 90%

“…At ROC curves analysis, with regard to predictive value of QT indexes towards diagnosis of cirrhosis, the best cut-off for the analyzed markers of ventricular dispersion were: QTmax (sensibility: 71.99 [95% CI: 67,2e76,6], specificity: 75. 13 …”

Section: Roc Curvesmentioning

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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“…This is true even in the case of elevated plasma norepinephrine concentrations. This phenomenon may appear both in patients with alcoholic and non-alcoholic liver disease and correlates with the severity of cirrhosis [2,35,36].…”

Section: Chronotropic Incompetencementioning

confidence: 99%

“…In patients with cirrhosis, the lengthening of the QT interval does not seem to be related to the etiology of the liver disease, and appears both in alcoholic and non-alcoholic subjects [35,36]. The prevalence of QT prolongation is high in patients with cirrhosis and increases with the severity of the liver disease.…”

Section: Qt Interval and Dispersionmentioning

confidence: 99%

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

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Hyperdynamic circulation, systolic and diastolic left ventricular dysfunction and certain electrophysiological abnormalities have been associated with cirrhosis and known for a long time. These clinical features have been introduced as cirrhotic cardiomyopathy (CCM), which is characterized by blunted myocardial contractile responsiveness to physical, physiological and pharmacological stress. Importantly, cardiac dysfunction can be reversible and can improve due to effective medical treatment and also after liver transplantation. Echocardiography and electrocardiography are essential tools for recognizing the characteristic changes in the myocardial function and also the alterations in the electrophysiological properties of the heart. Laboratory markers are auxiliary modalities further aiding the establishment of the correct diagnosis. In this review, we aimed to collect the pathophysiological background and clinical characteristics of CCM with the intention of summarizing the current possibilities for the diagnosis establishment and treatment of this cardio-hepatic disorder.Abbreviations: A: late diastolic transmitral peak flow velocity; ACE: angiotensin converting enzyme; ANP: atrial natriuretic peptide; ARB: angiotensin receptor blocker; BNP: brain natriuretic peptide; cAMP: cyclic adenosine monophosphate; CCM: cirrhotic cardiomyopathy; CGRP: calcitonin gene-related peptide; CO: carbon monoxide; DD: diastolic dysfunction; DT: deceleration time; E: early diastolic transmitral peak flow velocity; Ea: early diastolic velocity of the septal mitral annulus; EF: ejection fraction; MUGA: Multi Gated Acquisition Scan; NO: nitric oxide; NSBB: non-selective beta-blocker; pro-BNP: pro-brain natriuretic peptide; QTc: corrected QT interval; RAAS: renin-angiotensin aldosterone system; RALES: Randomized Aldactone Evaluation Study; suPAR: urokinase-type plasminogen activator receptor; TDI: Tissue Doppler Imaging; TIPS: transjugular intrahepatic portosystemic shunt; TNF-alpha: tumor necrosis factor-alpha.

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“…9,10 Other parasympathetic test results (standing to lying, Valsalva ratio, and HR variation with deep breathing) have also been shown to be abnormal in these patients. 7 Test results of sympathetic function (passive tilting and isometric exercise) are also abnormal and again point to decreased end-organ responsiveness to NE.…”

Section: Discussionmentioning

confidence: 95%

Autonomic dysfunction in end-stage liver disease manifested as defecation syncope: Impact of orthotopic liver transplantation

et al. 1999

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Patients with end-stage liver disease (ESLD) may be at increased risk for syncopal episodes based on their circulatory physiological state. Although a definitive cause for this is not known, several mechanisms have been proposed. In patients with ESLD, defecation syncope may result from a failure of short-term neurocirculatory adaptation to the Valsalva maneuver in the face of a hyperdynamic circulatory state and a decreased effective intravascular volume. We describe 2 patients with ESLD who had repeated episodes of defecation syncope before orthotopic liver transplantation (OLT). The most effective treatment of these syncopal episodes appears to be fluid administration and the use of a pressor agent, such as dopamine, to help maintain both an effective heart rate and intravascular volume. Correction of this altered circulatory physiological state through OLT prevented further syncopal episodes in both patients. A search of the literature failed to show previous reports associating ESLD and defecation syncope. Possible mechanisms favoring this association are reviewed.

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Autonomic Regulation of Heart Rate and QT Interval in Nonalcoholic Cirrhosis with Ascites

Cited by 39 publications

References 18 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

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Autonomic dysfunction in end-stage liver disease manifested as defecation syncope: Impact of orthotopic liver transplantation

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