Prolonged QT-interval in cirrhosis: is it reversible?

Abstract

For decades a characteristic cardiovascular pattern has been recognized in patients with end-stage liver disease characterized by low systemic vascular resistance and high cardiac output. This hyperdynamic state seems to affect development of complications and the course of the disease in these patients [ [1] Møller S. Hove J.D. Dixen U. Bendtsen F. New insights into cirrhotic cardiomyopathy. Int. J. Cardiol. 2013; 167: 1101-1108 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar ]. Despite a hyperdynamic circulation the physiologic response to strain is abnormal and may lead to overt heart failure after invasive procedures and for example to development of hepatic nephropathy as part of a cardiorenal syndrome [ [1] Møller S. Hove J.D. Dixen U. Bendtsen F. New insights into cirrhotic cardiomyopathy. Int. J. Cardiol. 2013; 167: 1101-1108 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar ]. The term cirrhotic cardiomyopathy (CCM) designates an impaired cardiac contractility with blunted inotropic and chronotropic response to stress, impaired diastolic relaxation, and presence of electrophysiological abnormalities [ 1 Møller S. Hove J.D. Dixen U. Bendtsen F. New insights into cirrhotic cardiomyopathy. Int. J. Cardiol. 2013; 167: 1101-1108 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 2 Bernardi M. Maggioli C. Dibra V. Zaccherini G. QT interval prolongation in liver cirrhosis: innocent bystander or serious threat?. Expert Rev Gastroenterol Hepatol. 2012 Feb; 6: 57-66 Crossref PubMed Scopus (53) Google Scholar , 3 Izzy M. Vanwagner L.B. Lin G. et al. Redefining cirrhotic cardiomyopathy for the modern era. Hepatology. 2019 Jul 25; 71: 345 Google Scholar ]. The electrophysiological abnormalities comprise prolonged QT interval, electromechanical dyssynchrony, and chronotropic incompetence [ [1] Møller S. Hove J.D. Dixen U. Bendtsen F. New insights into cirrhotic cardiomyopathy. Int. J. Cardiol. 2013; 167: 1101-1108 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar ]. Prolongation of the QT interval is the most prevalent abnormality and is seen in 40‐–60% of patients with cirrhosis awaiting liver transplantion (2;4). The QT-interval is indicative of delayed repolarization of the myocardial cells and can lead to severe arrhythmia and even sudden cardiac death [ [2] Bernardi M. Maggioli C. Dibra V. Zaccherini G. QT interval prolongation in liver cirrhosis: innocent bystander or serious threat?. Expert Rev Gastroenterol Hepatol. 2012 Feb; 6: 57-66 Crossref PubMed Scopus (53) Google Scholar ]. Prolonged QT-interval in cirrhosis has variably been associated with severity of the liver disease, degree of portal hypertension, and survival (1;2). The recent years have seen new attempts to refine the definition of CCM and QT-interval prolongation is a supportive criterion for the diagnosis of CCM, but used alone it is insufficient to diagnose CCM [ [3] Izzy M. Vanwagner L.B. Lin G. et al. Redefining cirrhotic cardiomyopathy for the modern era. Hepatology. 2019 Jul 25; 71: 345 Google Scholar ]. Whether and when the QT-interval changes after liver transplantation is controversial, but important to recognize as an indication of whether CCM is reversible after liver transplantation.