Document Detail


QT interval prolongation and decreased heart rate variability in cirrhotic patients: relevance of hepatic venous pressure gradient and serum calcium.
MedLine Citation:
PMID:  19076059     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A prolongation of QT interval has been shown in patients with cirrhosis and it is considered as part of the definition of the so-called 'cirrhotic cardiomyopathy'. The aim of the present study was to assess the determinants of QT interval prolongation in cirrhotic patients. Forty-eight male patients with different stages of liver disease were divided into three subgroups according to the Child-Pugh classification. All patients underwent a 24-h ECG Holter recording. The 24-h mean of QT intervals corrected for heart rate (termed QTc) and the slope of the regression line QT/RR were calculated. HRV (heart rate variability), plasma calcium and potassium concentration and HVPG (hepatic venous pressure gradient) were measured. QTc was progressively prolonged from Child A to Child C patients (P=0.001). A significant correlation between QTc and HVPG was found (P=0.003). Patients with alcohol-related cirrhosis presented QTc prolongation more frequently than patients with post-viral cirrhosis (P<0.001). The QT/RR slope was steeper in subjects with alcoholic aetiology as compared with viral aetiology (P=0.02), suggesting that these patients have a further QTc prolongation when heart rate decreases. The plasma calcium concentration was inversely correlated with QTc (P<0.001). The presence of severe portal hypertension was associated with decreased HRV (P<0.001). Cirrhotic patients with a more severe disease, especially of alcoholic aetiology, who have greater HVPG and lower calcium plasma levels, have an altered ventricular repolarization and a reduced vagal activity to the heart, which may predispose to life-threatening arrhythmias.
Authors:
Simonetta Genovesi; Daniela M Prata Pizzala; Massimo Pozzi; Laura Ratti; Maria Milanese; Federico Pieruzzi; Antonio Vincenti; Andrea Stella; Giuseppe Mancia; Marco Stramba-Badiale
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Publication Detail:
Type:  Journal Article     Date:  2009-05-14
Journal Detail:
Title:  Clinical science (London, England : 1979)     Volume:  116     ISSN:  1470-8736     ISO Abbreviation:  Clin. Sci.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-11     Completed Date:  2009-08-03     Revised Date:  2011-05-25    
Medline Journal Info:
Nlm Unique ID:  7905731     Medline TA:  Clin Sci (Lond)     Country:  England    
Other Details:
Languages:  eng     Pagination:  851-9     Citation Subset:  IM    
Affiliation:
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, via Cadore 48, Monza 20052, Italy. simonetta.genovesi@unimib.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Calcium / metabolism
Cardiomyopathies / ultrasonography
Echocardiography
Electrocardiography, Ambulatory
Humans
Liver Cirrhosis / blood,  complications*,  physiopathology
Long QT Syndrome / blood,  etiology*,  physiopathology
Male
Middle Aged
Portal Pressure / physiology
Chemical
Reg. No./Substance:
7440-70-2/Calcium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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