Kim Kyoung-Sun, Kwon Hye-Mee, Jung Kyeo-Woon, Sang Bo-Hyun, Moon Young-Jin, Kim Bomi, Jun In-Gu, Song Jun-Gol, Hwang Gyu-Sam
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Gastroenterol Hepatol. 2021 Mar;36(3):758-766. doi: 10.1111/jgh.15179. Epub 2020 Jul 30.
The proportional increase of corrected QT interval (QTc) along end-stage liver disease (ESLD) severity may lead to inconsistent outcome reporting if based on conventional threshold of prolonged QTc. We investigated the comprehensive QTc distribution among ESLD patients and assessed the association between QTc > 500 ms, a criterion for diagnosing severe long-QT syndrome, and the 30-day major adverse cardiovascular event (MACE) after liver transplantation (LT) and identified the risk factors for developing QTc > 500 ms.
Data were collected prospectively from the Asan LT Registry between 2011 and 2018, and outcomes were retrospectively reviewed. Multivariable analysis and propensity score-weighted adjusted odds ratios (ORs) were calculated. Thirty-day MACEs were defined as the composite of cardiovascular mortality, arrhythmias, myocardial infarction, pulmonary thromboembolism, and/or stroke.
Of 2579 patients, 194 (7.5%) had QTc > 500 ms (QTc500_Group), and 1105 (42.8%) had prolonged QTc (QTcP_Group), defined as QTc > 470 ms for women and >450 ms for men. The 30-day MACE occurred in 336 (13%) patients. QTc500_Group showed higher 30-day MACE than did those without (20.1% vs 12.5%, P = 0.003), with corresponding adjusted OR of 1.24 (95% CI: 1.06-1.46, P = 0.007). However, QTcP_Group showed comparable 30-day MACE (13.3% vs 12.8% without prolonged QTc, P = 0.764). Significant risk factors for QTc > 500 ms development were advanced liver disease, female sex, hypokalemia, hypocalcemia, high left ventricular end-diastolic volume, and tachycardia.
Our results revealed that, among ESLD patients, a novel threshold of QTc > 500 ms was associated with post-LT 30-day MACE but not with conventional threshold, indicating that a longer QTc threshold should be considered for this unique patient population.
如果基于校正QT间期（QTc）延长的传统阈值，随着终末期肝病（ESLD）严重程度的增加，QTc的比例增加可能导致结果报告不一致。我们研究了ESLD患者的综合QTc分布，并评估了QTc>500 ms（诊断严重长QT综合征的标准）与肝移植（LT）后30天主要不良心血管事件（MACE）之间的关联，并确定了发生QTc>500 ms的危险因素。
前瞻性收集2011年至2018年峨山LT登记处的数据，并对结果进行回顾性审查。计算多变量分析和倾向评分加权调整比值比（OR）。30天MACE定义为心血管死亡、心律失常、心肌梗死、肺血栓栓塞和/或中风的综合。
在2579例患者中，194例（7.5%）QTc>500 ms（QTc500组），1105例（42.8%）QTc延长（QTcP组），女性QTc>470 ms，男性>450 ms定义为QTc延长。336例（13%）患者发生30天MACE。QTc500组30天MACE高于未发生者（20.1%对12.5%，P=0.003），相应调整OR为1.24（95%CI：1.06-1.46，P=0.007）。然而，QTcP组30天MACE相当（13.3%对QTc未延长者的12.8%，P=0.764）。QTc>500 ms发生的显著危险因素为晚期肝病、女性、低钾血症、低钙血症、左心室舒张末期容积增加和心动过速。
我们的结果显示，在ESLD患者中，新的QTc>500 ms阈值与LT后30天MACE相关，但与传统阈值无关，表明对于这一独特患者群体应考虑更长的QTc阈值。
