Effect of liver transplantation on QT interval prolongation and autonomic dysfunction in end-stage liver disease

Abstract

Both a prolonged QT interval and disturbance of autonomic nervous system function are markers of poor prognosis in patients with diabetes mellitus and alcoholic liver disease (ALD). We studied the prevalence of abnormal QT interval and autonomic nervous system dysfunction in 53 consecutive patients with end-stage liver disease before and after orthotopic liver transplantation (OLT). The maximum QT interval in any lead (QTmax) was assessed by two independent observers. The QTmax, corrected for heart rate (QTcmax) was prolonged in 44 patients (83%), although increased QT dispersion was not found. There was a significant correlation between the QTcmax and Child-Pugh score but not with etiology. Evidence of parasympathetic dysfunction was present in 41 patients (77%), and sympathetic dysfunction was present in 20 patients before OLT. Fifty-two patients underwent transplantation. There was significant improvement in the QTcmax interval after OLT (P < .001); 32 of the 44 patients with prolonged QTcmax ( > 440 milliseconds) improved. Repeat testing was not performed in 7 patients, because they had died or had not undergone transplantation. Indices of parasympathetic function improved in 27 patients after OLT, but no improvement was observed in 8. Improvement in sympathetic dysfunction was observed in 13 of the 19 patients tested. There was no association between QTcmax, autonomic dysfunction, and survival. These results suggest that both prolonged QTcmax and some tests of autonomic function are temporary and arise as a consequence of liver dysfunction.

QT prolongation is associated with increased mortality in end stage liver disease

“…In addition, partial or full reversal of QT prolongation following liver transplantation has also been noted[14,26-31]. Contrary to these findings, in our study, QT c prolongation was not significantly influenced by etiology, age, beta-blocker use, or transplantation.…”

“…A number of studies have evaluated the association between QT prolongation and severity of ESLD as measured by Child-Pugh scores[14,19,24,25,28,36]. The majority of such studies have shown an increase in QT prolongation in association with higher Child-Pugh scores with the exception of studies done by Carey et al[27] and Adigun et al[30].…”

“…Thus, this may be a modifiable condition and amenable to therapy. Although some studies suggest a prolonged QT interval is related to severity of liver disease, etiology of liver disease, and increased mortality, conflicting results exist regarding these important clinical questions[14,19,24-30,35,36]. …”

Cirrhotic cardiomyopathy: review of pathophysiology and treatment

“…Multiple studies revealed impaired hemodynamic responses to physical (exercise) and pharmacological stress [2, 3]. These abnormalities were initially believed to be a direct toxic effect of alcohol; however, subsequent studies in human and animal models of nonalcoholic cirrhosis demonstrated similar manifestation of blunted cardiac contractility in response to stress and electrophysiological abnormality [4–6]. This disorder was formally termed as “cirrhotic cardiomyopathy.” In this review, we summarized the pathyphysiology and clinical significance of cirrhotic cardiomyopathy.…”

Alteration of the QT variability index in end-stage liver disease

“…The major electrocardiographic change in cirrhosis is the prolongation of the QT interval, which is related to the severity of cirrhosis, and is independent of its etiology [3,4,5]. The prolongation of QT interval is associated with malignant ventricular arrhythmia and sudden cardiac death in end-stage liver disease (ESLD) and myocardial infarction [5,6,7].…”