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.
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Research Article|
May 14 2009
QT interval prolongation and decreased heart rate variability in cirrhotic patients: relevance of hepatic venous pressure gradient and serum calcium
Simonetta Genovesi;
*Department of Clinical Medicine and Prevention, University of Milano-Bicocca, via Cadore 48, Monza 20052, Italy
†Nephrology Unit, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
Correspondence: Dr Simonetta Genovesi (email [email protected]).
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Daniela M. Prata Pizzala;
Daniela M. Prata Pizzala
‡Medical Division, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Massimo Pozzi;
Massimo Pozzi
‡Medical Division, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Laura Ratti;
Laura Ratti
†Nephrology Unit, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Maria Milanese;
Maria Milanese
‡Medical Division, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Federico Pieruzzi;
Federico Pieruzzi
*Department of Clinical Medicine and Prevention, University of Milano-Bicocca, via Cadore 48, Monza 20052, Italy
†Nephrology Unit, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Antonio Vincenti;
Antonio Vincenti
§Electrophysiology and Cardiac Pacing Unit, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Andrea Stella;
Andrea Stella
‡Medical Division, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Giuseppe Mancia;
Giuseppe Mancia
‡Medical Division, S. Gerardo Hospital, via Pergolesi 33, Monza 20052, Italy
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Marco Stramba-Badiale
Marco Stramba-Badiale
∥Department of Rehabilitation Medicine, IRCCS Istituto Auxologico Italiano, via Mosè Bianchi 90, Milano 20149, Italy
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Publisher: Portland Press Ltd
Received:
July 17 2008
Revision Received:
December 09 2008
Accepted:
December 10 2008
Accepted Manuscript online:
December 10 2008
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2009 Biochemical Society
2009
Clin Sci (Lond) (2009) 116 (12): 851–859.
Article history
Received:
July 17 2008
Revision Received:
December 09 2008
Accepted:
December 10 2008
Accepted Manuscript online:
December 10 2008
Citation
Simonetta Genovesi, Daniela M. Prata Pizzala, Massimo Pozzi, Laura Ratti, Maria Milanese, Federico Pieruzzi, Antonio Vincenti, Andrea Stella, Giuseppe Mancia, Marco Stramba-Badiale; QT interval prolongation and decreased heart rate variability in cirrhotic patients: relevance of hepatic venous pressure gradient and serum calcium. Clin Sci (Lond) 1 June 2009; 116 (12): 851–859. doi: https://doi.org/10.1042/CS20080325
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