<scp>QT</scp> interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis

Trevisani, Franco; Micoli, Antonio Di; Zambruni, Andrea; Biselli, Maurizio; Santi, Valentina; Erroi, Virginia; Lenzi, B.; Caraceni, Paolo; Domenicali, Marco; Cavazza, Mario; Bernardi, Mauro

doi:10.1111/j.1478-3231.2012.02847.x

Cited by 53 publications

(46 citation statements)

References 23 publications

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“…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%

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: 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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“…Therefore, a sudden increase in this activity caused by acute gastrointestinal bleeding further lengthens this time interval with potential adverse outcomes. Trevisani et al [73] showed that in a group of cirrhotic patients with this complication, the QT interval lengthened at the time of bleeding and all those that died had a longer QTc than survivors. In addition, QTc was able to independently predict survival, with a best cut-off value of ≥ 460 ms.…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

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Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation of the myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of the β-adrenergic receptor. Diagnosis can be made using a combination of echocardiography (resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy. Core tip: Cirrhotic cardiomyopathy is characterised by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation and prolongation of the QT interval. It is only recently that it has been recognised as a definitive clinical entity, and yet it has significant implications in a number of clinical situations in which there is increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Liver transplantation is one such situation, and in this review we discuss criteria for diagnosis, possible methods to limit further deterioration and the perioperative management of these patients.

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“…In the presence of ion channel alteration (as stated above), the influence of sympathetic activity on QT interval might be different from normal individuals. This hypothesis was supported by the increased risk of cardiac arrhythmia with elevated sympathetic activity in patients with type 1 and 5 long QT syndromes, who possessed mutant genes coding for delayed rectified potassium channels in the heart [59]. Moreover, a sudden rise in sympathetic tone could transiently prolong QTc interval as shown in a recent study in cirrhotic patients with acute gastrointestinal (GI) bleeding [60].…”

Section: Clinical Manifestation and Pathophysiologic Processmentioning

confidence: 99%

Cirrhotic cardiomyopathy: review of pathophysiology and treatment

Chayanupatkul

Liangpunsakul

2014

Hepatol Int

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Cirrhotic cardiomyopathy is a cardiac condition observed in patients with cirrhotic regardless of the etiologies. It is characterized by the impaired systolic response to physical stress, diastolic dysfunction, and electrophysiological abnormalities, especially QT interval prolongation. Its pathophysiology and clinical significance has been a focus of various researchers for the past decades. The impairment of β-adrenergic receptor, the increase in endogenous cannabinoids, the presence of cardiosuppressants such as nitric oxide and inflammatory cytokines are the proposed mechanisms of systolic dysfunction. The activation of cardiac renin-angiotensin system and salt retention play the role in the development of cardiac hypertrophy and impaired diastolic function. QT interval prolongation, which is observed in 40-50 % of cirrhotic patients, occurs as a result of the derangement in membrane fluidity and ion channel defect. The increased recognition of this disease will prevent the complications of overt heart failure after procedures such as transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation. Better understandings of the pathogenesis and pathology of cirrhotic cardiomyopathy is crucial in developing more accurate diagnostic tools and specific treatments of this condition.

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QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis

Cited by 53 publications

References 23 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

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Cirrhotic cardiomyopathy: review of pathophysiology and treatment

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