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Hepatology 1998 Jan;27(1):28-34
Q-T interval prolongation in cirrhosis: prevalence, relationship
with severity, and etiology of the disease and possible pathogenetic factors.
Bernardi M, Calandra S, Colantoni A, Trevisani F, Raimondo ML, Sica G,
Schepis F, Mandini M, Simoni P, Contin M, Raimondo G
Prolonged Q-T interval predicts severe arrhythmias and sudden death, and has
been shown to occur in alcoholic liver disease and cirrhotic patients who are
candidates for liver transplantation. This study first evaluated the prevalence
of prolonged Q-T interval in a large population of unselected patients with
cirrhosis, and assessed the relationship between abnormal Q-T, etiology, and
severity of liver disease and mortality of patients. Possible causes of Q-T
abnormality were also explored. Ninety-four patients with cirrhosis without
overt heart disease and 37 control subjects with mild chronic active hepatitis
were enrolled. Rate-corrected Q-T interval (Q-Tc) was assessed along with routine
liver tests, Child-Pugh score, serum bile salts, electrolytes and creatinine,
plasma renin activity, aldosterone, norepinephrine, atrial natriuretic factor
and, gonadal hormones. Q-Tc was longer in patients with cirrhosis than in controls
(440.3 +/- 3.2 vs. 393.6 +/- 3.7 ms; P <.001) and prolonged (> 440 ms)
in 44 patients (46.8%) and 2 controls (5.4%; P <.001). Q-Tc length was not
influenced by the etiology of cirrhosis and correlated with Child-Pugh score
(r = .53; P .001), liver tests such as prothrombin activity, and serum concentrations
of albumin and bilirubin, plasma bile salts, and plasma norepinephrine. Multivariate
analysis showed that only Child-Pugh score and plasma norepinephrine were independently
correlated with Q-Tc duration. Over a median follow-up period of 19 months (range,
2-33 months), patients with Q-Tc longer than 440 ms had a significantly lower
survival rate than those with normal Q-Tc. Q-T interval is frequently prolonged
in patients with cirrhosis, regardless the etiology of the disease, worsens
in parallel with the severity of the disease, and may have an important prognostic
meaning. In addition to other undefined factors related to the severity of cirrhosis,
sympathoadrenergic hyperactivity may play a pathogenetic role.
PMID: 9425913, UI: 98085882
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