Liver cirrhosis-effect on QT interval and cardiac autonomic nervous system activity

Abstract

AIMTo examine the impact of liver cirrhosis on QT interval and cardiac autonomic neuropathy (CAN).METHODSA total of 51 patients with cirrhosis and 51 controls were examined. Standard 12-lead electrocardiogram recordings were obtained and QT as well as corrected QT interval (QTc) and their dispersions (dQT, dQTc) were measured and calculated using a computer-based program. The diagnosis of CAN was based upon the battery of the tests proposed by Ewing and Clarke and the consensus statements of the American Diabetes Association. CAN was diagnosed when two out of the four classical Ewing tests were abnormal.RESULTSQT, QTc and their dispersions were significantly longer (P < 0.01) in patients with cirrhosis than in controls. No significant differences in QT interval were found among the subgroups according to the etiology of cirrhosis. Multivariate regression analysis after controlling for age, gender and duration of cirrhosis demonstrated significant association between QT and presence of diabetes mellitus [standardized regression coefficient (beta) = 0.45, P = 0.02] and treatment with diuretics (beta = 0.55, P = 0.03), but not with the Child-Pugh score (P = 0.54). Prevalence of CAN was common (54.9%) among patients with cirrhosis and its severity was associated with the Child-Pugh score (r = 0.33, P = 0.02). Moreover, patients with decompensated cirrhosis had more severe CAN that those with compensated cirrhosis (P = 0.03). No significant association was found between severity of CAN and QT interval duration.CONCLUSIONPatients with cirrhosis have QT prolongation. Treatment with diuretics is associated with longer QT. CAN is common in patients with cirrhosis and its severity is associated with severity of the disease.

Non-Alcoholic Cirrhosis and Heart Rate Variability: A Systematic Mini-Review

“…were prolonged in patients with cirrhosis in comparison with healthy controls and that cirrhosis patients were diagnosed more often with cardiac autonomic dysfunction. Besides that, authors found that ANS activity cardiac is affected strongly by the severity of cirrhosis and probably contributes to the development of cirrhotic myocardiopathy [34].…”

Electrocardiographic Changes in Liver Cirrhosis—Clues for Cirrhotic Cardiomyopathy

“…Studies suggest that increased levels of norepinephrine correlate with QTc values [29]. Furthermore, the mechanism is opposite to that in normal subjects, where excess norepinephrine produces a lower QTc [33]; a clinical consequence of the autonomic dysfunction was the lack of increased heart rate despite high levels of norepinephrine, possibly due to down-regulation of beta-receptors.…”

Response to the Letter to the Editor

“…This is a linear regression-based method for cirrhosis in our association of bilirubin with QT interval. We agree that liver cirrhosis has been associated with a prolonged QT interval (Tsiompanidis et al, 2018). Nevertheless, we adjusted our models for alanine aminotransferase and aspartate aminotransferase which can be elevated in liver disease especially in nonalcoholic fatty liver disease (Sehatpour et al, 2020), a common cause of liver cirrhosis in the United States (Negro, 2020).…”