Akboga Mehmet Kadri, Yuksel Mahmut, Balci Kevser Gulcihan, Kaplan Mustafa, Cay Serkan, Gokbulut Volkan, Yayla Cagri, Ertem Ahmet Goktug, Ayhan Meral Akdogan, Topaloglu Serkan, Aras Dursun
Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Department of Gastroenterology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Ann Noninvasive Electrocardiol. 2017 Jan;22(1). doi: 10.1111/anec.12359. Epub 2016 Apr 7.
Arrhythmias and electrocardiographic changes are reported in several noncardiac diseases, including liver cirrhosis (LC). We intended to evaluate the interval from the peak to the end of the electrocardiographic T wave (Tp-e), Tp-e/QTc ratio, and fQRS as presumed markers of arrhythmias in LC.
In this cross-sectional study, a total of 88 consecutive patients with LC according to clinical, biological, ultrasonographic, or histological criteria and 73 control subjects were enrolled. The severity of cirrhosis was classified according to Pugh-Child's classification and Model for End-Stage Liver Disease (MELD) score. Tp-e interval, Tp-e/QTc ratio, and fQRS rates were measured from the 12-lead electrocardiogram.
Tp-e interval, Tp-e/QTc ratio and fQRS rates were significantly increased in parallel to the severity of LC (P < 0.001, P < 0.001, and P = 0.003, respectively). In correlation analysis, Pugh-Child stage showed a significantly positive correlation with Tp-e interval (r = 0.462, P < 0.001), QTc interval (r = 0.373, P < 0.001), Tp-e/QTc ratio (r = 0.352, P < 0.001), and fQRS (r = 0.407, P < 0.001). Furthermore, Tp-e interval (r = 0.414, P < 0.001) and Tp-e/QTc ratio (r = 0.426, P< 0.001) had significant positive correlation with MELD score.
Our study demonstrated that Tp-e interval, Tp-e/QTc ratios, and fQRS rates were significantly increased in parallel to the severity of LC. Thus, these findings may implicate that Tp-e interval, Tp-e/QTc ratio, and fQRS may be novel and useful indicators for prediction of arrhythmias in LC.
在包括肝硬化（LC）在内的几种非心脏疾病中，均有关于心律失常和心电图变化的报道。我们旨在评估心电图T波峰至终点的间期（Tp-e）、Tp-e/QTc比值以及碎裂QRS波（fQRS），将其作为肝硬化中心律失常的推测标志物。
在这项横断面研究中，根据临床、生物学、超声或组织学标准，共纳入了88例连续的肝硬化患者以及73名对照者。肝硬化的严重程度根据Pugh-Child分级和终末期肝病模型（MELD）评分进行分类。从12导联心电图测量Tp-e间期、Tp-e/QTc比值和fQRS发生率。
Tp-e间期、Tp-e/QTc比值和fQRS发生率均随着肝硬化严重程度的增加而显著升高（分别为P < 0.001、P < 0.001和P = 0.003）。在相关性分析中，Pugh-Child分期与Tp-e间期（r = 0.462，P < 0.001）、QTc间期（r = 0.373，P < 0.001）、Tp-e/QTc比值（r = 0.352，P < 0.001）以及fQRS（r = 0.407，P < 0.001）均呈显著正相关。此外，Tp-e间期（r = 0.414，P < 0.001）和Tp-e/QTc比值（r = 0.426，P < 0.001）与MELD评分呈显著正相关。
我们的研究表明，Tp-e间期、Tp-e/QTc比值和fQRS发生率均随着肝硬化严重程度的增加而显著升高。因此，这些发现可能意味着Tp-e间期、Tp-e/QTc比值和fQRS可能是预测肝硬化中心律失常的新型有用指标。
