Prognostic Value of a New Marker of Ventricular Repolarization in Cirrhotic Patients

• Main Authors: Angelo Antunes Salgado, Paulo Roberto Benchimol Barbosa, Alinne Gimenez Ferreira, Camila Aparecida de Souza Segrégio Reis, Carlos Terra
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Cardiologia (SBC)
• Series: Arquivos Brasileiros de Cardiologia
• Subjects: Cirrose Hepática / etiologia; Cirrose Hepática / mortalidade; Cardiomiopatias / fisiopatologia; Eletrocardiografia; Prognóstico; Disfunção Ventricular Esquerda / fisiopatologia
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2016004500523&lng=en&tlng=en

Abstract Background: There is still debate about the relationship between changes in ventricular repolarization on the surface electrocardiogram and cirrhosis severity. Objective: To study the relationship between variables related to ventricular repolarization and the clinical severity of the cirrhotic disease. Methods: We selected 79 individuals with hepatic cirrhosis, classified according to the Child-Pugh-Turcotte criteria (Child A, B, and C). We measured the QT and corrected QT (QTc) intervals, and the interval between the peak and the end of the T wave (TpTe), and we identified their minimum, maximum, and mean values in the 12-lead electrocardiogram. We also calculated the dispersion of the QT (DQT) and QTc (DQTc) intervals. Results: In 12 months of clinical follow-up, nine subjects underwent hepatic transplantation (Child A: 0 [0%]; Child B: 6 [23.1%]; Child C: 3 [18.8%]; p = 0.04) and 12 died (Child A: 3 [12.0%]; Child B: 4 [15.4%]; Child C: 5 [31.3%]; p = 0.002). No significant differences were observed between the cirrhotic groups related to the minimum, maximum, and mean values for the QT, QTc, TpTe, DQT, and DQTc intervals. A minimum TpTe interval ≤ 50 ms was a predictor for the composite endpoints of death or liver transplantation with a sensitivity of 90% and a specificity of 57% (p = 0.005). In the Cox multivariate analysis, the Child groups and a minimum TpTe of ≤ 50 ms were independent predictors of the composite endpoints. Conclusion: The intervals QT, QTc, DQT, DQTc, and TpTe have similar distributions between different severity stages in cirrhotic disease. The TpTe interval proved to be a prognostic marker in subjects with cirrhosis, regardless of disease severity (NCT01433848).