Han Huanqin, Chen Junlian, Deng Zhirong, Li Tingting, Qi Xiaoying, Deng Wei, Wu Zunge, Xiao Chuli, Zheng Weiqiang, Du Yujun
Department of Infectious Diseases and Hepatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
Cardiovascular Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
Front Pharmacol. 2024 Apr 26;15:1370261. doi: 10.3389/fphar.2024.1370261. eCollection 2024.
Prolonged QT intervals are extremely common in patients with cirrhosis and affect their treatment outcomes. Propranolol is often used to prevent gastroesophageal variceal hemorrhage in patients with cirrhosis; however, it is uncertain whether propranolol exerts a corrective effect on QT interval prolongation in patients with cirrhosis.
The study aimed to investigate the therapeutic effects of propranolol on patients with cirrhosis and prolonged QT intervals.
A retrospective cohort study approach was adopted. Patients with cirrhosis complicated by moderate-to-severe gastroesophageal varices, who were hospitalized at the Affiliated Hospital of Guangdong Medical University between 1 December 2020 and 31 November 2022, were included in the study. The patients were divided into the propranolol and control groups based on whether they had received propranolol. Upon admission, the patients underwent tests on liver and kidney functions, electrolytes, and coagulation function, as well as abdominal ultrasonography and electrocardiography. In addition to conventional treatment, the patients were followed up after the use or non-use of propranolol for treatment and subsequently underwent reexamination of the aforementioned tests.
The propranolol group (26 patients) had an average baseline corrected QT (QTc) interval of 450.23 ± 37.18 ms, of which 14 patients (53.8%) exhibited QTc interval prolongation. Follow-up was continued for a median duration of 7.00 days after the administration of propranolol and conventional treatment. Electrocardiographic reexamination revealed a decrease in the QTc interval to 431.04 ± 34.64 ms ( = 0.014), and the number of patients with QTc interval prolongation decreased to five (19.2%; < 0.001). After treatment with propranolol and multimodal therapy, QTc interval normalization occurred in nine patients with QTc interval prolongation, leading to a normalization rate of 64.3% (9/14). The control group (n = 58) had an average baseline QTc interval of 453.74 ± 30.03 ms, of which 33 patients (56.9%) exhibited QTc interval prolongation. After follow-up for a median duration of 7.50 days, the QTc interval was 451.79 ± 34.56 ms ( = 0.482), and the number of patients with QTc interval prolongation decreased to 30 (51.7%; = 0.457). The QTc interval normalization rate of patients in the control group with QTc interval prolongation was merely 10.0% (3/33), which was significantly lower than that in the propranolol group ( < 0.001).
In patients with cirrhosis complicated by QT interval prolongation, the short-term use of propranolol aids in correction of a long QT interval and provides positive therapeutic value for cirrhotic cardiomyopathy.
肝硬化患者中QT间期延长极为常见，且会影响其治疗效果。普萘洛尔常用于预防肝硬化患者的胃食管静脉曲张出血；然而，普萘洛尔对肝硬化患者QT间期延长是否具有纠正作用尚不确定。
本研究旨在探讨普萘洛尔对肝硬化合并QT间期延长患者的治疗效果。
采用回顾性队列研究方法。纳入2020年12月1日至2022年11月31日在广东医科大学附属医院住院的肝硬化合并中重度胃食管静脉曲张患者。根据是否接受普萘洛尔治疗将患者分为普萘洛尔组和对照组。入院时，患者接受肝肾功能、电解质、凝血功能检查以及腹部超声和心电图检查。除常规治疗外，在使用或未使用普萘洛尔治疗后对患者进行随访，随后再次进行上述检查。
普萘洛尔组（26例患者）的平均基线校正QT（QTc）间期为450.23±37.18毫秒，其中14例患者（53.8%）出现QTc间期延长。在给予普萘洛尔和常规治疗后，继续随访的中位时间为7.00天。心电图复查显示QTc间期降至431.04±34.64毫秒（P = 0.014），QTc间期延长的患者数量降至5例（19.2%；P < 0.001）。在接受普萘洛尔和多模式治疗后，14例QTc间期延长的患者中有9例QTc间期恢复正常，正常化率为64.3%（9/14）。对照组（n = 58）的平均基线QTc间期为453.74±30.03毫秒，其中33例患者（56.9%）出现QTc间期延长。随访中位时间为7.50天后，QTc间期为451.79±34.56毫秒（P = 0.482），QTc间期延长的患者数量降至30例（51.7%；P = 0.457）。对照组中QTc间期延长患者的QTc间期正常化率仅为10.0%（3/33），显著低于普萘洛尔组（P < 0.001）。
在肝硬化合并QT间期延长的患者中，短期使用普萘洛尔有助于纠正长QT间期，对肝硬化性心肌病具有积极的治疗价值。
