Day C P, James O F, Butler T J, Campbell R W
Department of Academic Cardiology, Medical School, University of Newcastle, Newcastle upon Tyne, UK.
Lancet. 1993 Jun 5;341(8858):1423-8. doi: 10.1016/0140-6736(93)90879-l.
Cardiovascular death is the most important cause of mortality in alcoholics, yet alcohol may protect against ischaemic heart disease. This could be explained if deaths were a consequence of alcohol-related arrhythmias rather than of coronary atheroma. In many conditions, abnormalities of the QT interval are markers of arrhythmia and for risk of sudden death. We examined the relation between QT intervals and mortality in patients with alcoholic liver disease. Simultaneous 12-lead electrocardiographic recordings were obtained from 69 patients with histologically proven alcoholic liver disease (without evidence of structural heart disease), and from 40 healthy non-drinking controls matched for age and sex. Patients were abstinent for at least 7 days before investigation to exclude acute effects of alcohol. QT intervals were corrected for rate with Bazett's and cube root formulae to define QTc and QTcub, respectively. Unlike QTc, QTcub was independent of rate. Patients were followed for up to four years. For those who died, the cause was determined from case records and postmortem reports. Maximum QT intervals were longer in alcoholics than in controls (QTcub 450 vs 439, p = 0.016). This difference was not explained by variations in electrolytes. QT intervals were prolonged in the 14 patients who died compared with survivors (QTcub 471 vs 446, p = 0.007). This difference was mainly due to the long QT intervals in the 6 patients with sudden cardiac deaths (QTcub 493). The only other factor independently associated with death was sex. QT interval prolongation occurs in some patients with alcoholic liver disease and is associated with an adverse prognosis, especially sudden cardiac death. QT measurement should be included in the initial assessment of alcoholic patients, particularly in those considered for liver transplantation.
心血管死亡是酗酒者最重要的死亡原因，然而酒精可能对缺血性心脏病具有保护作用。如果死亡是酒精相关心律失常而非冠状动脉粥样硬化的结果，这一点或许可以得到解释。在许多情况下，QT间期异常是心律失常和猝死风险的标志物。我们研究了酒精性肝病患者QT间期与死亡率之间的关系。从69例经组织学证实患有酒精性肝病（无结构性心脏病证据）的患者以及40例年龄和性别匹配的健康非饮酒对照者中获取同步12导联心电图记录。患者在调查前至少戒酒7天以排除酒精的急性影响。分别使用Bazett公式和立方根公式对QT间期进行心率校正，以定义校正QT间期（QTc）和校正立方根QT间期（QTcub）。与QTc不同，QTcub与心率无关。对患者进行了长达四年的随访。对于死亡患者，根据病例记录和尸检报告确定死因。酗酒者的最大QT间期比对照组更长（QTcub 450对439，p = 0.016）。这种差异无法用电解质的变化来解释。与存活者相比，14例死亡患者的QT间期延长（QTcub 471对446，p = 0.007）。这种差异主要是由于6例心源性猝死患者的QT间期较长（QTcub 493）。唯一与死亡独立相关的其他因素是性别。QT间期延长在一些酒精性肝病患者中出现，并且与不良预后相关，尤其是心源性猝死。QT测量应纳入酒精性患者的初始评估中，特别是对于那些考虑进行肝移植的患者。
