Electrocardiographic Changes in Liver Cirrhosis—Clues for Cirrhotic Cardiomyopathy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population
- history of cardiovascular disease;
- antiarrhythmic treatment in the previous 6 months, including beta-blockers, or use of any other medication that can alter ECG patterns;
- diuretic treatment in the previous month;
- presence of pulmonary diseases (evaluated by history, clinical examination and chest radiography);
- presence of stage 3 or above chronic kidney disease or acute chronic kidney disease;
- presence of arrhythmias on ECG on admission;
- history of alcohol abuse;
- history of autoimmune liver disease;
- presence of hepatocellular carcinoma or other malignancies;
- anemia with hemoglobin levels under 10 g/dL;
- presence of thyroid disease (hypo or hyperthyroidism, autoimmune thyroiditis).
2.2. Electrocardiography Analysis
- QRS amplitude in all limb (DI, DII, DIII, aVL, aVF and aVR) and precordial (V1-V6) leads. Criteria for low-voltage QRS was amplitude of less than 0.5 mV in one of the limb leads and less than 1 mV in one of the precordial leads [23]. Mean values for QRS voltage in the limb leads and QRS voltage in the precordial leads were also calculated;
- QT interval, measured in leads DII and V6, from the beginning of the QRS interval to the end of the T wave. The lead with the longest QT interval was then considered, and the average QT interval from three consecutive heartbeats was recorded. Corrected QT (QTc) was calculated using Bazzet’s formula:QTc= QT/√RR.QT prolongation was defined as a corrected length interval of over 440 ms in male patients and over 460 ms in female patients;
- Tpe was calculated in all the leads using the tangent method, and a mean value was recorded. The peak was measured at the highest amplitude of the T wave relative to the isoelectric line. The T-end was defined as the intersection of the downslope of the T wave with the isoelectric line [24]. If there was a U wave present, the end of the T wave was considered at the lowest point between the T and the U waves.
2.3. Echocardiography Confirmation
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. ECG Characteristics
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Parameter | Chronic hepatitis (N = 54) | Cirrhosis Child A (N = 18) | Cirrhosis Child B (N = 20) | Cirrhosis Child C (N = 25) | p Value |
---|---|---|---|---|---|
Age (y) | 48.4 +/− 5.3 | 50.4 +/− 10.5 | 55.7 +/− 13.2 | 60.8 +/− 14.3 | 0.0043 |
Gender (M/F) | 25/29 | 9/9 | 11/9 | 11/14 | 0.67 |
Etiology (HBV/HCV) | 28/26 | 8/10 | 7/13 | 9/14 | 0.589 |
ALT (IU/mL) | 46 +/− 28 | 62+/− 23 | 75 +/− 39 | 77 +/− 45 | 0.52 |
AST (IU/mL) | 78 +/− 45 | 104+/− 67 | 112 +/− 53 | 101 +/− 62 | 0.25 |
Total bilirubin (mg/dL) | 0.5 +/− 0.4 | 1.2 +/− 0.7 | 2.5 +/− 1.3 | 7.1 +/− 3.8 | 0.035 |
Albumin (g/dL) | 4.2 +/− 0.6 | 3.3 +/− 0.3 | 3.1 +/− 0.7 | 2.8 +/− 0.9 | 0.028 |
Total cholesterol (mg/dL) | 212 +/− 39 | 177 +/− 48 | 152 +/− 46 | 134 +/− 72 | 0.045 |
Ammonia (μg/dL) | 32 +/− 17 | 47 +/− 12 | 71 +/− 23 | 89 +/− 21 | 0.021 |
Creatinine (mg/dL) | 0.9 +/− 0.3 | 0.9 +/− 0.4 | 1.0 +/− 0.3 | 0.9 +/− 0.4 | 0.626 |
Sodium (mEq/L) | 143 +/− 3 | 140 +/− 4 | 136 +/− 4 | 131 +/− 6 | 0.05 |
Potassium (mEq/L) | 4.4 +/− 0.5 | 4.2+/− 0.6 | 4.3 +/ 0.5 | 4.1 +/− 0.7 | 0.274 |
Total calcium (mg/dL) | 9.4 +/− 0.8 | 9.2 +/− 0.7 | 9.3+/− 0.6 | 9.0 +/− 0.7 | 0.053 |
Magnesium (mg/dL) | 2.1 +/− 0.5 | 2.1+/− 0.7 | 2.0 +/− 0.6 | 1.9 +/− 1.7 | 0.62 |
Phosphorus (mg/dL) | 3.6 +/− 1.2 | 3.2 +/− 0.7 | 3.3 +/− 0.4 | 3.0 +/− 0.8 | 0.09 |
Bicarbonate (mmol/L) | 24 +/− 3 | 25 +/− 4 | 23 +/− 4 | 23 +/− 5 | 0.13 |
INR | 0.9 +/− 0.1 | 1.1 +/0.3 | 1.3 +/− 0.2 | 2.2 +/− 1,5 | 0.0012 |
LVEF (%) | 62 +/− 9 | 55 +/− 6 | 52 +/− 7 | 52 +/− 3 | 0.07 |
Septal e’ velocity (cm/s) | 12 +/− 3 | 11 +/− 3 | 8 +/− 2 | 6 +/− 2 | 0.01 |
E/e’ ratio | 19 +/− 3 | 16 +/− 4 | 13 +/− 4 | 11 +/− 2 | 0.001 |
Parameter | Chronic Hepatitis (N = 54) | Cirrhosis Child A (N = 18) | Cirrhosis Child B (N = 20) | Cirrhosis Child C (N = 25) | p Value | |
---|---|---|---|---|---|---|
Mean QRS voltage | Precordial Leads | 10.2 +/− 3.5 | 9.8 +/− 2.5 | 9.1 +/− 3.1 | 8.9 +/− 2.9 | 0.043 |
Limb Leads | 5.1 +/− 1.9 | 4.9 +/− 1.4 | 4.8 +/− 2.1 | 4.5 +/− 1.7 | 0.032 | |
Criteria for QRS Hypovoltage | 3 (5.5%) | 6 (33.33%) | 12 (60%) | 16 (64%) | 0.041 | |
Heart Rate (bpm) | 81 +/− 19 | 82 +/− 21 | 88 +/− 16 | 92 +/− 15 | 0.039 | |
QRS Duration (ms) | 85 +/ 16 | 85 +/− 14 | 83 +/− 12 | 84 +/− 17 | 0.134 | |
QTc (ms) | 418 +/− 1 | 445 +/− 27 | 451 +/− 23 | 459 +/− 31 | 0.045 | |
Criteria for Prolonged QT | 2 (3,7%) | 6 (33.33%) | 10 (50%) | 13 (52%) | 0.021 | |
Mean Tpe (ms) | 73 +/− 18 | 71 +/− 17 | 70 +/− 23 | 64 +/− 15 | 0.023 | |
Criteria for Shortened Tpe (<50ms) | 1 (1.8%) | 3 (16.66%) | 9 (45%) | 15 (60%) | 0.034 |
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Toma, L.; Stanciu, A.M.; Zgura, A.; Bacalbasa, N.; Diaconu, C.; Iliescu, L. Electrocardiographic Changes in Liver Cirrhosis—Clues for Cirrhotic Cardiomyopathy. Medicina 2020, 56, 68. https://doi.org/10.3390/medicina56020068
Toma L, Stanciu AM, Zgura A, Bacalbasa N, Diaconu C, Iliescu L. Electrocardiographic Changes in Liver Cirrhosis—Clues for Cirrhotic Cardiomyopathy. Medicina. 2020; 56(2):68. https://doi.org/10.3390/medicina56020068
Chicago/Turabian StyleToma, Letitia, Adriana Mercan Stanciu, Anca Zgura, Nicolae Bacalbasa, Camelia Diaconu, and Laura Iliescu. 2020. "Electrocardiographic Changes in Liver Cirrhosis—Clues for Cirrhotic Cardiomyopathy" Medicina 56, no. 2: 68. https://doi.org/10.3390/medicina56020068