Arya Sanjeev, Kumar Prashant, Tiwari Bhuwan, Belwal Shantanu, Saxena Sanjay, Abbas Haider
Department of Critical Care, Max Super Specialty Hospital (Previously), Dehradun, India.
Department of Critical Care, Kailash Hospital, Noida, Uttar Pradesh, India.
Indian J Crit Care Med. 2020 Dec;24(12):1251-1255. doi: 10.5005/jp-journals-10071-23695.
Impairment of cardiac function and arrhythmias often coexist in patients with liver diseases. Many studies have proved this coexistence and put forward various theories toward its pathophysiology. This narrative review tries to find the answers with supporting evidence on five main questions:Do high serum bilirubin levels have a strong association with cardiac arrhythmias?Can corrected QT interval (QTc) be relied upon for predicting a risk factor toward imminent arrhythmias?Is there an association between QTc prolongation and mortality?Are high serum bilirubin and cardiac dysfunction closely associated?What is the probable pathophysiology behind this association?
Clinical evidence was obtained by using search engines, namely, Cochrane Library, PubMed, and Google Scholar. Studies published in journals in the English language, between January 1969 and December 2019, which mentioned the relationship between cardiac arrhythmia and liver disease, were included. We used the keywords: jaundice, bilirubin, arrhythmia, ECG, QTc interval, QT dispersion, liver, and cirrhosis. Relevant animal or human studies answering the five main questions were extracted and reviewed.
The evidence included in our review sheds light on the fact that approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy (CC) and there has been an association between liver abnormalities and cardiac pathology. The present review also supports that there exists a strong association between high levels of serum bilirubin levels and cardiac arrhythmias, QTc value can be relied upon as a risk factor for predicting imminent arrhythmias, and that it is associated with mortality. Its basic pathophysiology can be explained by the potential action of bile acids in prolonging the QT interval. It also causes cardiac hypertrophy and apoptosis of cardiomyocytes leading to cardiac dysfunction.
Arya S, Kumar P, Tiwari B, Belwal S, Saxena S, Abbas H. What Every Intensivist should Know about Impairment of Cardiac Function and Arrhythmias in Liver Disease Patients: A Review. Indian J Crit Care Med 2020;24(12):1251-1255.
心脏功能损害和心律失常在肝病患者中常常并存。许多研究已证实了这种并存情况，并针对其病理生理学提出了各种理论。本叙述性综述试图通过支持性证据来回答五个主要问题：血清胆红素水平升高与心律失常是否存在强关联？校正QT间期（QTc）能否用于预测即将发生心律失常的危险因素？QTc延长与死亡率之间是否存在关联？血清胆红素水平升高与心脏功能障碍是否密切相关？这种关联背后可能的病理生理学是什么？
通过使用搜索引擎，即考克兰图书馆、PubMed和谷歌学术搜索来获取临床证据。纳入1969年1月至2019年12月期间发表在英文期刊上、提及心律失常与肝病之间关系的研究。我们使用了以下关键词：黄疸、胆红素、心律失常、心电图、QTc间期、QT离散度、肝脏和肝硬化。提取并综述了回答这五个主要问题的相关动物或人体研究。
我们综述中纳入的证据揭示了这样一个事实，即约50%的肝硬化病例会发展为肝硬化性心肌病（CC），并且肝脏异常与心脏病理之间存在关联。本综述还支持血清胆红素水平升高与心律失常之间存在强关联，QTc值可作为预测即将发生心律失常的危险因素，且与死亡率相关。其基本病理生理学可通过胆汁酸延长QT间期的潜在作用来解释。它还会导致心肌肥厚和心肌细胞凋亡，进而导致心脏功能障碍。
Arya S, Kumar P, Tiwari B, Belwal S, Saxena S, Abbas H. 肝病患者心脏功能损害和心律失常，每位重症监护医生应了解的内容：综述。《印度重症监护医学杂志》2020；24(12):1251 - 1255。
