Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Feb 15, 2018; 9(1): 28-36
Published online Feb 15, 2018. doi: 10.4291/wjgp.v9.i1.28
Liver cirrhosis-effect on QT interval and cardiac autonomic nervous system activity
Elias Tsiompanidis, Spyros I Siakavellas, Anastasios Tentolouris, Ioanna Eleftheriadou, Stamatia Chorepsima, Anastasios Manolakis, Konstantinos Oikonomou, Nikolaos Tentolouris
Elias Tsiompanidis, Spyros I Siakavellas, Anastasios Tentolouris, Ioanna Eleftheriadou, Stamatia Chorepsima, Anastasios Manolakis, Konstantinos Oikonomou, Nikolaos Tentolouris, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece
Author contributions: Tsiompanidis E, Siakavellas SI, Tentolouris A, Eleftheriadou I, Chorepsima S, Manolakis A, Oikonomou K and Tentolouris N were involved in the design of the study, interpretation of results and writing of the manuscript; Tsiompanidis E, Siakavellas SI and Manolakis A participated in data acquisition; Tentolouris A, Eleftheriadou I, Chorepsima S and Tentolouris N conducted the statistical analysis; all authors read and approved the final manuscript.
Institutional review board statement: The experimental protocol was reviewed and approved by the Ethics Committee of Laiko General Hospital (Number of Permission: 2903/10-12-2014).
Informed consent statement: The study was approved by the ethics committee of Laiko General Hospital and written informed consent was obtained from all individuals before participation in the study.
Conflict-of-interest statement: There are no conflicts of interest related to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nikolaos Tentolouris, Associate Professor, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens 11527, Greece. ntentol@med.uoa.gr
Telephone: +30-213-2061061 Fax: +30-213-2061794
Received: August 6, 2017
Peer-review started: August 7, 2017
First decision: September 7, 2017
Revised: October 4, 2017
Accepted: October 30, 2017
Article in press: October 30, 2017
Published online: February 15, 2018
Abstract
AIM

To examine the impact of liver cirrhosis on QT interval and cardiac autonomic neuropathy (CAN).

METHODS

A total of 51 patients with cirrhosis and 51 controls were examined. Standard 12-lead electrocardiogram recordings were obtained and QT as well as corrected QT interval (QTc) and their dispersions (dQT, dQTc) were measured and calculated using a computer-based program. The diagnosis of CAN was based upon the battery of the tests proposed by Ewing and Clarke and the consensus statements of the American Diabetes Association. CAN was diagnosed when two out of the four classical Ewing tests were abnormal.

RESULTS

QT, QTc and their dispersions were significantly longer (P < 0.01) in patients with cirrhosis than in controls. No significant differences in QT interval were found among the subgroups according to the etiology of cirrhosis. Multivariate regression analysis after controlling for age, gender and duration of cirrhosis demonstrated significant association between QT and presence of diabetes mellitus [standardized regression coefficient (beta) = 0.45, P = 0.02] and treatment with diuretics (beta = 0.55, P = 0.03), but not with the Child-Pugh score (P = 0.54). Prevalence of CAN was common (54.9%) among patients with cirrhosis and its severity was associated with the Child-Pugh score (r = 0.33, P = 0.02). Moreover, patients with decompensated cirrhosis had more severe CAN that those with compensated cirrhosis (P = 0.03). No significant association was found between severity of CAN and QT interval duration.

CONCLUSION

Patients with cirrhosis have QT prolongation. Treatment with diuretics is associated with longer QT. CAN is common in patients with cirrhosis and its severity is associated with severity of the disease.

Keywords: QT interval, Cardiac autonomic neuropathy, Cirrhotic cardiomyopathy, Child-Pugh score, Model for end-stage liver disease score, Liver cirrhosis

Core tip: QT interval is significantly prolonged in patients with liver cirrhosis and its duration is associated with the use of diuretics but not with the severity of the disease. More than half of the patients with cirrhosis have cardiac autonomic neuropathy (CAN), while CAN severity is associated strongly with the severity of cirrhosis.