Relationship between QT interval prolongation and structural abnormalities in cirrhotic cardiomyopathy: A change in the current paradigm

Abstract

It is postulated that cardiac structural abnormalities observed in cirrhotic cardiomyopathy (CCM) contribute to the electrophysiologic abnormality of QT interval (QTc) prolongation. We sought to evaluate whether QTc prolongation is associated with intrinsic abnormalities in cardiac structure and function that characterize CCM. Consecutive patients undergoing liver transplant work‐up between 2010 and 2018 were included. Measures of cardiac function on stress testing including cardiac reserve and chronotropic incompetence were collected prospectively and a corrected QTc ≥ 440 ms was considered prolonged. Overall, 439 patients were included and 65.1% had a prolonged QTc. There were no differences in markers of left ventricular and atrial remodeling, or resting systolic and diastolic function across QTc groups. The proportion of patients that met the criteria for a low cardiac reserve (39.2 vs 36.6%, p = .66) or chronotropic incompetence (18.1 vs 21.3%, p = .52) was not different in those with a QTc ≥ 440 vs <440 ms. Further, there was no association between QTc prolongation and CCM by either the 2005 World College of Gastroenterology or modified 2020 Cirrhotic Cardiomyopathy Consortium criteria. QT interval prolongation was not associated with structural or functional cardiac abnormalities that characterize CCM. These findings suggest that CCM and QT interval prolongation in cirrhosis may be two separate entities with distinct pathophysiological origins.

Prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria. Alterations in ultrasonographic parameters of both left and right ventricles before and after stress

“…However, patients with LVDD had a significant longer QTc, a trend for higher BNP and a trend to older age. QTc interval prolongation has been correlated with the severity and complications of cirrhosis in several previous studies, but data are still controversial [28,29]. In our study, a significant but not so strong correlation was found between the QTc and Child-Pugh score.…”

The predictive value of revised diastolic dysfunction in outcomes of liver transplantation: A propensity score matching analysis

“…A prolonged QT interval is the main electrophysiological signature of CCM, which is associated with 30-day cardiovascular AEs and mortality, post-LT (30,31). In the 2019 CCC consensus, QT prolongation was not warranted, because of its limited value in the diagnosis of CCM (32,33). Potassium is the major predictive factor of perioperative cardiovascular AEs.…”

Prolonged QT Interval in Cirrhosis: Twisting Time?

“…However, what role these mechanisms play in the genesis of repolarization abnormalities in cirrhosis remains unclear. Indeed, a recent study by Koshy et al 84 demonstrated no correlation between LQTS and either the 2005 World Congress of Gastroenterology or 2020 Cirrhotic Cardiomyopathy Consortium diagnostic criteria for cirrhotic cardiomyopathy,suggesting that LQTS and cirrhotic cardiomyopathy are separate and unrelated phenomena. However, this conclusion is controversial, with some believing that he presence of cirrhotic cardiomyopathy may contribute to the manifestation of LQTS, and also increase the risk of fatal arrhythmias.…”