Cirrhotic Patients with Child-Pugh C Have Longer QT Intervals

Abstract Background and aims: Cirrhotic cardiomyopathy has been used to describe chronic cardiac dysfunction in cirrhotic patients with no previous structural heart disease. Additionally, QT prolongation is one of the most important cardiac alterations related to cirrhosis. Previous studies suggest that QT prolongation is associated with a higher mortality rate among cirrhotic patients. The aim of this study was to analyze QT intervals according to cirrhosis severity as measured by the Child-Pugh classification. Materials and methods: In a cross-sectional study, a total of 67 patients with nonalcoholic cirrhosis underwent clinical and electrocardiographic evaluation. Cirrhosis severity was classified according to the Child-Pugh score. The QT interval was measured by a 12-lead electrocardiogram. Results: The QT intervals were longer in patients in the Child-Pugh C group than those in the Child-Pugh A and B groups (459 ± 33 vs 436 ± 25 and 428 ± 34 ms, respectively, p = 0.004). There was a positive correlation between the QT interval and the Child-Pugh score in individuals with Child-Pugh scores ≥ 7 (r = 0.50, p &lt; 0.05) and QT intervals ≥ 440 ms (r = 0.46, p &lt; 0.05). Conclusion: The present study showed longer QT intervals in patients with Child-Pugh C cirrhosis, which reinforced the relationship between the severity of cirrhosis and electrocardiographic findings of cirrhotic cardiomyopathy. Moreover, this finding emerged in patients with no cardiac symptoms, which highlighted the importance of a simple and noninvasive method (ECG) to identify cirrhotic patients with cardiomyopathy.摘要 背景与目的：肝硬化心肌病（Cirrhotic cardiomyopathy）被用于描述无既往结构性心脏病的肝硬化患者所发生的慢性心功能不全。此外，QT间期延长（QT prolongation）是与肝硬化相关的最为重要的心脏异常表现之一。既往研究提示，肝硬化患者出现QT间期延长与更高的病死率相关。本研究旨在依据Child-Pugh分级（Child-Pugh classification）所评估的肝硬化严重程度，分析QT间期的变化特征。材料与方法：本研究为横断面研究，共纳入67例非酒精性肝硬化患者，对其开展临床评估与心电图（electrocardiogram, ECG）检查。肝硬化严重程度依照Child-Pugh评分进行分级。采用12导联心电图测量QT间期。结果：Child-Pugh C级患者的QT间期较A、B级患者更长，分别为459±33 ms、436±25 ms和428±34 ms，p=0.004。在Child-Pugh评分≥7分（r=0.50，p<0.05）以及QT间期≥440 ms（r=0.46，p<0.05）的受试者中，QT间期与Child-Pugh评分呈正相关。结论：本研究证实，Child-Pugh C级肝硬化患者的QT间期更长，这进一步强化了肝硬化严重程度与肝硬化心肌病心电图表现之间的关联。此外，该现象在无心脏症状的患者中同样存在，这凸显了采用简便无创的心电图（ECG）方法识别合并心肌病的肝硬化患者的重要临床价值。