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Markedly prolonged QTc interval in end‐stage liver disease and risk of 30‐day cardiovascular event after liver transplant
Author(s) -
Kim KyoungSun,
Kwon HyeMee,
Jung KyeoWoon,
Sang BoHyun,
Moon YoungJin,
Kim Bomi,
Jun InGu,
Song JunGol,
Hwang GyuSam
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15179
Subject(s) - medicine , qt interval , mace , cardiology , odds ratio , myocardial infarction , liver transplantation , liver disease , hypokalemia , transplantation , percutaneous coronary intervention
Background and Aim 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. Methods 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. Results 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. Conclusion 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.