Prolonged QTc Interval Is an Electrophysiological Hallmark of Cirrhotic Cardiomyopathy


BACKGROUND: Cirrhotic Cardiomyopathy is a relatively ill-characterized condition, which is often under-diagnosed due to absence of defined diagnostic criteria. ECG showing corrected QT Interval prolongation is the most suitable available option for diagnosis of this condition. OBJECTIVE: To determine the frequency of corrected QT interval prolongation in patients with liver cirrhosis. METHODOLOGY: Patients (n = 166) with confirmed cirrhosis, 30 years or older, presented in the outpatient and emergency department of medicine at Capital Hospital Islamabad between 1 October 2011 and 30 September 2012, were enrolled in this cross-sectional study after taking consent. ECG was done using calibrated ECG machine, and the QT Interval was measured. Corrected QT was calculated using Bazett’s formula and a QTc of more than 0.44 seconds was considered as being prolonged. RESULTS: The mean age of the patients was 57.05 ± 12.03 years. The corrected QT Interval varied from 337 ms to 560 ms. The mean QTc Interval was 429.92 ms ± 45.11. QTc was prolonged in 41 out of 166 patients (24.7%). Frequency of QTc prolongation was 4.5% in Child Pugh Grade A, 23.2% in Child Pugh Grade B, and 32.0% in Child Pugh Grade C. Association of Child Pugh Scoring with QTc prolongation was determined and found to be statistically significant (P < 0.05). CONCLUSION: QTc interval was prolonged in 24.7% of cirrhotic patients in our study. There was a significant increase in frequency with worsening of Child Pugh Grade, thereby indicating an association between QTc prolongation and the severity of cirrhosis.

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Bashir Bhatti, A. , Ali, F. and Akbar Satti, S. (2014) Prolonged QTc Interval Is an Electrophysiological Hallmark of Cirrhotic Cardiomyopathy. Open Journal of Internal Medicine, 4, 33-39. doi: 10.4236/ojim.2014.41006.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Heidelbaugh, J.J. and Bruderly, M. (2006) Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation. American Family Physician, 74, 756-62.
[2] Stroffolini, T., Sagnelli, E., Almasio, P., et al. (2004) Characteristics of Liver Cirrhosis in Italy: Results from a Multicenter National Study. Digestive and Liver Disease, 36, 56-60.
[3] Anderson, R.N. And Smith, B.L. (2003) Deaths: Leading Causes for 2001. National Vital Statistics Reports, 52, 1-85.
[4] Haliday, M.L., Coates, R.A. and Rankin, J.G. (1991) Changing Trends of Cirrhosis Mortality in Ontario, Canada 1911-1986. International Journal of Epidemiology, 20, 199-208.
[5] Kowalski, H.J. and Abelmann, W.H. (1953) The Cardiac Output at Rest in Laennec’s Cirrhosis. Journal of Clinical Investigation, 32, 1025-1033.
[6] Abelmann, W.H., Kowalski, H.J. and McNeely, W.F. (1955) The Hemodynamic Response to Exercise in Patients with Laennec’s Cirrhosis. Journal of Clinical Investigation, 34, 690-695.
[7] Zuberi, B.F., Ahmed, S., Faisal, N., et al. (2007) Comparison of Heart Rate and QTc Duration in Patients of Cirrhosis of Liver with Non-Cirrhotic Controls. Journal of the College of Physicians and Surgeons Pakistan, 17, 69-71.
[8] Chugh, S.S., Reinier, K., Singh, T., et al. (2009) Determinants of prolonged QT Interval and Their Contribution to Sudden Death Risk in Coronary Artery Disease: The Oregon Sudden Unexpected Death Study. Circulation, 119, 663-670.
[9] Bernardi, M., Calandra, S., Colantoni, A., et al. (1998) Q-T Interval Prolongation in Cirrhosis: Prevalence, Relationship with Severity, and Etiology of the Disease and Possible Pathogenetic Factors. Hepatology, 27, 28-34.
[10] Walsh, K. and Alexander, G.J. (2001) Update on Chronic Viral Hepatitis. Postgraduate Medical Journal, 77, 498-505.
[11] Smedsrod, B., Pertoft, H., Gustafson, S., et al. (1990) Scavenger Functions of the Liver Endothelial Cell. Biochemical Journal, 266, 313-327.
[12] Ripoll, C., Catalina, M.V., Yotti, R., et al. (2008) Cardiac Dysfunction during Liver Transplantation: Incidence and Preoperative Predictors. Transplantation, 85, 1766-1772.
[13] Alqahtani, S.A., Fouad, T.R. and Lee, S.S. (2008) Cirrhotic Cardiomyopathy. Seminars in Liver Disease, 28, 59-69.
[14] Jessup, M., Abraham, W.T., Casey, D.E., et al. (2009) 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration with the International Society for Heart and Lung Transplantation. Journal of the American College of Cardiology, 53, 1343-1382.
[15] Makkar, R.R., Fromm, B.S., Steinman, R.T., et al. (1993) Female Gender as a Risk Factor for Torsades de Pointes Associated with Cardiovascular Drugs. JAMA, 270, 2590-2597.
[16] Li, L., Liu, H.R., Shu, J.L., et al. (2007) Clinical Investigation of Q-T Prolongation in Hepatic Cirrhosis. Zhonghua Yi Xue Za Zhi, 87, 2717-2718.
[17] Bal, J.S. and Thuluvath, P.J. (2003) Prolongation of QTc Interval: Relationship with Etiology and Severity of Liver Disease, Mortality and Liver Transplantation. Liver International, 23, 243-248.
[18] Kosar, F., Ates, F., Sahin, I., et al. (2007) QT Interval Analysis in Patients with Chronic Liver Disease: A Prospective Study. Angiology, 58, 218-24.

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