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Effect of QT interval prolongation on cardiac arrest following liver transplantation and derivation of a risk index
Author(s) -
Koshy Anoop N.,
Ko Jefferson,
Farouque Omar,
Cooray Shamil D.,
Han HuiChen,
Cailes Benjamin,
Gow Paul J.,
Weinberg Laurence,
Testro Adam,
Lim Han S.,
Teh Andrew W.
Publication year - 2021
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16145
Subject(s) - medicine , qt interval , liver transplantation , cardiology , odds ratio , perioperative , confidence interval , torsades de pointes , anesthesia , heart transplantation , transplantation
Liver transplantation (LT) has a 4‐fold higher risk of periprocedural cardiac arrest and ventricular arrhythmias (CA/VAs) compared with other noncardiac surgeries. Prolongation of the corrected QT interval (QTc) is common in patients with liver cirrhosis. Whether it is associated with an increased risk of CA/VAs following LT is unclear. Rates of 30‐day CA/VAs post‐LT were assessed in consecutive adults undergoing LT between 2010 and 2017. Pretransplant QTc was measured by a cardiologist blinded to clinical outcomes. Among 408 patients included, CA/VAs occurred in 26 patients (6.4%). QTc was significantly longer in CA/VA patients (475 ± 34 vs 450 ± 34 ms, P < .001). Optimal QTc cut‐off for prediction of CA/VAs was ≥480 ms. After adjustment, QTc ≥480 ms remained the strongest predictor for the occurrence of CA/VAs (odds ratio [OR] 5.2, 95% confidence interval [CI] 2.2‐12.6). A point‐based cardiac arrest risk index (CARI) was derived with the bootstrap method for yielding optimism‐corrected coefficients (2 points: QTc ≥480, 1 point: Model for End‐Stage Liver Disease [MELD] ≥30, 1 point: age ≥65, and 1 point: male). CARI score ≥3 demonstrated moderate discrimination (c‐statistic 0.79, optimism‐corrected c‐statistic 0.77) with appropriate calibration. QTc ≥480 ms was associated with a 5‐fold increase in the risk of CA/VAs. The CARI score may identify patients at higher risk of these events. Whether heightened perioperative cardiac surveillance, avoidance of QT prolonging medications, or beta blockers could mitigate the risk of CA/VAs in this population merits further study.