Prolonged QTc interval and its relationship to autonomic cardiovascular reflexes in patients with cirrhosis.
OBJECTIVE
We have previously shown that an abnormality in cardiac autonomic reflexes (AN) is an independent predictor of mortality in patients with chronic liver disease. Aim of this study was to determine whether there was an association between prolonged QTc interval and cardiac AN.


METHODS
Cardiac AN and QTc interval were determined in 130 patients (Child A 42, B 53, C 35) with alcoholic and non-alcoholic liver disease.


RESULTS
Prolonged QTc (>440ms) was seen in 58 (Child A 30%, B 46%, C 60%, P=0.04) patients. Autonomic tests were normal in 21%, borderline abnormal in 36% and definitely abnormal in 43%. QTc correlated with albumin (P<0.001), prothrombin time (P=0.003) and Child-Pugh score (P<0.001), but not with Valsalva ratio, heart rate variation with 6 breath/min breathing, tilt table or isometric exercise. By logistic regression analysis, QTc correlated only with Child-Pugh score (P<0.001). Mean QTc of 34 who died during the follow up was higher than survivors. Cox regression analysis showed that only Child-Pugh score and AN were independent predictors of mortality.


CONCLUSIONS
Prolonged QTc seen in liver disease is independent of their cardiac autonomic function, but is related to the severity of the liver disease.
Puthumana
L
L
Department of Medicine and Neurology, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA.
Chaudhry
V
V
Thuluvath
P J
PJ
D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D002319:Cardiovascular System / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012018:Reflex; D012021:Reflex, Abnormal; D016019:Survival Analysis