Cor Vasa 2017, 59(2):e105-e113 | DOI: 10.1016/j.crvasa.2016.01.010

Electrocardiographic findings in hepatic cirrhosis and their association with the severity of disease

Leili Pourafkari^a,b,c, Samad Ghaffari^a, Leila Nazeri^b, Janine B. Lee^c, Kourosh Masnadi-Shirazi^d, Arezou Tajlil^a, Nader D. Nader^c,*

^a Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

^b Department of Cardiology, Islamic Azad University (Tabriz Branch), Iran

^c School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States

^d Department of Gastroenterology, Tabriz University of Medical Sciences, Tabriz, Iran

Purpose/aim: Previous studies reported prolongation of QT interval in cirrhotic patients. We aimed to investigate the electrocardiographic changes and their correlation with the disease severity in cirrhotic patients.

Methods: Sixty-nine cirrhotic patients were examined. The prolongation of corrected QT interval and low--voltage QRS in electrocardiography were cross-examined for clinical and biochemical data. The association of electrocardiographic findings with the severity of cirrhosis, as determined by both Child-Pugh and model for end-stage liver diseases (MELD) scores, was investigated.

Results: QT-interval prolongation was detected in 63.5% patients and 57.7% met the criteria for low-voltage QRS. Patients with prolonged QT-interval had higher Child-Pugh scores (9.58 ± 2.5 vs. 8.16 ± 2.29 respectively, p = 0.04) but model for end-stage liver diseases scores was similar in those with prolonged QT and low-voltage electrocardiogram. The frequency of prolonged QT interval and low-voltage QRS were similar among patients with different Child-Pugh classes. Heart rate was also higher in patients with low-voltage electrocardiogram (89 ± 15 beats per minute vs. 79 ± 16 beats per minute, p = 0.01). Mean QRS voltage in precordial leads was lower in those with ascites (8.5 ± 2.6 mV vs. 11.8 ± 3.4 mV, p = 0.006).

Conclusion: Electrocardiographic changes are common in cirrhosis regardless of the disease severity. Low--voltage QRS may be related to anthropomorphic changes and development of ascites in these patients.

Keywords: Liver disease; Low-voltage electrocardiogram; QT interval

Received: November 7, 2015; Revised: January 14, 2016; Accepted: January 19, 2016; Published: April 1, 2017  Show citation