Relationship between QT interval prolongation and structural abnormalities in cirrhotic cardiomyopathy: A change in
Anoop N Koshy1,2, Paul J Gow2,3, Adam Testro2,3
1Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
Insights
QT interval prolongation in cirrhosis is not linked to cardiac structural or functional changes seen in cirrhotic cardiomyopathy (CCM). These conditions may have separate causes, suggesting distinct pathophysiological origins.
Area of Science:
- Cardiology
- Hepatology
- Electrophysiology
Background:
- Cirrhotic cardiomyopathy (CCM) is characterized by cardiac structural and functional abnormalities.
- QTc prolongation, an electrophysiologic abnormality, is often observed in patients with cirrhosis.
- The relationship between QTc prolongation and the cardiac changes in CCM is not fully understood.
Purpose of the Study:
- To investigate the association between QTc prolongation and intrinsic cardiac structural and functional abnormalities in patients with cirrhosis.
- To determine if QTc prolongation correlates with markers of cardiac remodeling, systolic/diastolic function, cardiac reserve, or chronotropic incompetence in the context of CCM.
Main Methods:
- Prospective study of 439 consecutive patients undergoing liver transplant work-up (2010-2018).
- Collected measures of cardiac function via stress testing, including cardiac reserve and chronotropic incompetence.
- Defined prolonged QTc as ≥440 ms and assessed CCM using established criteria.
Main Results:
- 65.1% of patients exhibited QTc prolongation (≥440 ms).
- No significant differences were found in left ventricular/atrial remodeling, resting cardiac function, cardiac reserve, or chronotropic incompetence between prolonged and normal QTc groups.
- QTc prolongation showed no association with CCM according to either the 2005 World College of Gastroenterology or 2020 Cirrhotic Cardiomyopathy Consortium criteria.
Conclusions:
- QT interval prolongation is not associated with the structural or functional cardiac abnormalities characteristic of CCM.
- CCM and QTc prolongation in cirrhosis may represent distinct clinical entities with separate pathophysiological mechanisms.
Abstract:
It is postulated that cardiac structural abnormalities observed in cirrhotic cardiomyopathy (CCM) contribute to the electrophysiologic abnormality of QT interval (QTc) prolongation. We sought to evaluate whether QTc prolongation is associated with intrinsic abnormalities in cardiac structure and function that characterize CCM. Consecutive patients undergoing liver transplant work-up between 2010 and 2018 were included. Measures of cardiac function on stress testing including cardiac reserve and chronotropic incompetence were collected prospectively and a corrected QTc ≥ 440 ms was considered prolonged. Overall, 439 patients were included and 65.1% had a prolonged QTc. There were no differences in markers of left ventricular and atrial remodeling, or resting systolic and diastolic function across QTc groups. The proportion of patients that met the criteria for a low cardiac reserve (39.2 vs 36.6%, p = .66) or chronotropic incompetence (18.1 vs 21.3%, p = .52) was not different in those with a QTc ≥ 440 vs <440 ms. Further, there was no association between QTc prolongation and CCM by either the 2005 World College of Gastroenterology or modified 2020 Cirrhotic Cardiomyopathy Consortium criteria. QT interval prolongation was not associated with structural or functional cardiac abnormalities that characterize CCM. These findings suggest that CCM and QT interval prolongation in cirrhosis may be two separate entities with distinct pathophysiological origins.
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