TY - JOUR
T1 - Effect of liver transplantation on QT-interval prolongation and impact on mortality
AU - Ko, Jefferson
AU - Koshy, Anoop N.
AU - Han, Hui Chen
AU - Weinberg, Laurence
AU - Gow, Paul
AU - Testro, Adam
AU - Lim, Han S.
AU - Farouque, Omar
AU - Teh, Andrew W.
PY - 2021/3
Y1 - 2021/3
N2 - Background: QT-interval prolongation is considered the electrophysiological hallmark of cirrhotic cardiomyopathy. However, the significance of QT-interval prolongation and how it is affected by liver transplantation (LT) remains unclear. Methods: Consecutive inpatients undergoing LT between 2010 and 2017 at a state-wide liver transplant center in Australia were included. Preoperative, early postoperative and long-term follow-up corrected QT-intervals (QTc) were manually measured by a cardiologist. QTc was calculated using the Bazett formula and QTc ≥440 milliseconds (ms) was considered prolonged. Results: Overall, 1111 ECG tracings among 408 patients (mean age 57 ± 12 years) were assessed. Pre-LT, 265 patients (65.0%) had QTc ≥440 ms and 24 patients (5.9%) had QTc ≥500 ms. In the early postoperative period, there was a significant increase in QTc compared to pre-LT (471 ± 39 vs. 452 ± 31 ms, p < 0.001) and 80 patients (20.3%) had QTc ≥500 ms. At a median of six months post-LT, there was significant reduction in mean QTc compared to pre-LT (430 ± 32 vs. 452 ± 31 ms; p < 0.001) with the QTc shortening in 73% of patients. QT-interval prolongation was not associated with postoperative complications or mortality at any time-point. Conclusion: QT-interval prolongation is common in patients with liver cirrhosis and this metric normalized in the majority within six months post-LT. A significant increase in QTc was noted early post-LT, with over 20% demonstrating QTc ≥500 ms. QT-interval prolongation was not associated with post-transplant complications or mortality. Resolution of QT-interval prolongation suggests that this feature of cirrhotic cardiomyopathy may reverse post-transplantation.
AB - Background: QT-interval prolongation is considered the electrophysiological hallmark of cirrhotic cardiomyopathy. However, the significance of QT-interval prolongation and how it is affected by liver transplantation (LT) remains unclear. Methods: Consecutive inpatients undergoing LT between 2010 and 2017 at a state-wide liver transplant center in Australia were included. Preoperative, early postoperative and long-term follow-up corrected QT-intervals (QTc) were manually measured by a cardiologist. QTc was calculated using the Bazett formula and QTc ≥440 milliseconds (ms) was considered prolonged. Results: Overall, 1111 ECG tracings among 408 patients (mean age 57 ± 12 years) were assessed. Pre-LT, 265 patients (65.0%) had QTc ≥440 ms and 24 patients (5.9%) had QTc ≥500 ms. In the early postoperative period, there was a significant increase in QTc compared to pre-LT (471 ± 39 vs. 452 ± 31 ms, p < 0.001) and 80 patients (20.3%) had QTc ≥500 ms. At a median of six months post-LT, there was significant reduction in mean QTc compared to pre-LT (430 ± 32 vs. 452 ± 31 ms; p < 0.001) with the QTc shortening in 73% of patients. QT-interval prolongation was not associated with postoperative complications or mortality at any time-point. Conclusion: QT-interval prolongation is common in patients with liver cirrhosis and this metric normalized in the majority within six months post-LT. A significant increase in QTc was noted early post-LT, with over 20% demonstrating QTc ≥500 ms. QT-interval prolongation was not associated with post-transplant complications or mortality. Resolution of QT-interval prolongation suggests that this feature of cirrhotic cardiomyopathy may reverse post-transplantation.
KW - Cirrhosis
KW - Cirrhotic cardiomyopathy
KW - Liver disease
KW - Liver transplantation
KW - QT interval
UR - http://www.scopus.com/inward/record.url?scp=85096376252&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2020.11.017
DO - 10.1016/j.ijcard.2020.11.017
M3 - Article
C2 - 33186663
AN - SCOPUS:85096376252
VL - 326
SP - 158
EP - 163
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -