Abstract
BackgroundAlthough cardiovascular disease is thouht to be common in cirrhosis, there are no systematic investigations on the prevalence of electrocardiographic (ECG) abnormalities in these patients and data on the occurrence of post-transplant cardiac events in comparison with the general population are lacking. We aimed to study the prevalence and predictors of ECG abnormalities in patients with cirrhosis undergoing liver transplantation and to define the risk of cardiac events post-transplant compared to the general population.MethodsCirrhotic patients undergoing first-time liver transplantation between 1999–2007 were retrospectively enrolled. ECGs at pre-transplant evaluation were reviewed using the Minnesota classification and compared to healthy controls. Standardized incidence ratios for post-transplant cardiac events were calculated.Results234 patients with cirrhosis were included, 186 with an available ECG (36% with alcoholic and 24% with viral cirrhosis; mean follow-up 4 years). Cirrhotics had a prolonged QTc interval, a Q wave, abnormal QRS axis deviation, ST segment depression and a pathologic T wave more frequently compared to controls (p < 0.05 for all). Arterial hypertension, older age, cirrhosis severity and etiology were related to ECG abnormalities. Compared to the general Swedish population, patients were 14 times more likely to suffer a cardiac event post-transplant (p < 0.001). A prolonged QTc interval and Q wave were related to post-transplant cardiac events (p < 0.05 for all).ConclusionsPre-transplant ECG abnormalities are common in cirrhosis and are associated with cardiovascular risk factors and cirrhosis severity and etiology. Post-transplant cardiac events are more common than in the general population.
Highlights
Cardiovascular disease is thouht to be common in cirrhosis, there are no systematic investigations on the prevalence of electrocardiographic (ECG) abnormalities in these patients and data on the occurrence of post-transplant cardiac events in comparison with the general population are lacking
In the current study we found an increased incidence of post-transplant cardiac events in liver transplant recipients compared to the general population as well as an increased prevalence of pre-transplant ECG abnormalities
For the calculation of standardized incidence ratio (SIR), data on the occurrence of cardiac events in the general Swedish population were obtained from the national inpatient hospital registry. 1Observed events; the number of observed events in our cohort. 2Expected events; the number of events that occurred in the age and gender matched group of the general population. 3All events occurring after liver transplantation until death or end of follow-up. 4All events occurring after the immediate inpatient post-transplant period
Summary
Cardiovascular disease is thouht to be common in cirrhosis, there are no systematic investigations on the prevalence of electrocardiographic (ECG) abnormalities in these patients and data on the occurrence of post-transplant cardiac events in comparison with the general population are lacking. We aimed to study the prevalence and predictors of ECG abnormalities in patients with cirrhosis undergoing liver transplantation and to define the risk of cardiac events post-transplant compared to the general population. Data on the risk of cardiac events in patients with liver cirrhosis following liver transplantation compared to the general population are largely lacking. Secondary aims were to define the risk for cardiac events in liver transplant recipients in relation to the general population and the potential relation of pretransplant ECG abnormalities to post-transplant cardiac morbidity and mortality
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