RESUMO
Abstract Background: There is still debate about the relationship between changes in ventricular repolarization on the surface electrocardiogram and cirrhosis severity. Objective: To study the relationship between variables related to ventricular repolarization and the clinical severity of the cirrhotic disease. Methods: We selected 79 individuals with hepatic cirrhosis, classified according to the Child-Pugh-Turcotte criteria (Child A, B, and C). We measured the QT and corrected QT (QTc) intervals, and the interval between the peak and the end of the T wave (TpTe), and we identified their minimum, maximum, and mean values in the 12-lead electrocardiogram. We also calculated the dispersion of the QT (DQT) and QTc (DQTc) intervals. Results: In 12 months of clinical follow-up, nine subjects underwent hepatic transplantation (Child A: 0 [0%]; Child B: 6 [23.1%]; Child C: 3 [18.8%]; p = 0.04) and 12 died (Child A: 3 [12.0%]; Child B: 4 [15.4%]; Child C: 5 [31.3%]; p = 0.002). No significant differences were observed between the cirrhotic groups related to the minimum, maximum, and mean values for the QT, QTc, TpTe, DQT, and DQTc intervals. A minimum TpTe interval ≤ 50 ms was a predictor for the composite endpoints of death or liver transplantation with a sensitivity of 90% and a specificity of 57% (p = 0.005). In the Cox multivariate analysis, the Child groups and a minimum TpTe of ≤ 50 ms were independent predictors of the composite endpoints. Conclusion: The intervals QT, QTc, DQT, DQTc, and TpTe have similar distributions between different severity stages in cirrhotic disease. The TpTe interval proved to be a prognostic marker in subjects with cirrhosis, regardless of disease severity (NCT01433848).
Resumo Fundamento: Ainda há debate sobre a relação de alterações da repolarização ventricular ao eletrocardiograma de superfície e a gravidade da cirrose. Objetivo: Estudar a relação entre variáveis relacionadas à repolarização ventricular e a gravidade clínica da doença cirrótica. Métodos: Foram selecionados 79 sujeitos com cirrose hepática, classificados segundo os critérios Child-Pugh-Turcotte (Child A, B e C). Foram medidos intervalos QT e QT corrigido (QTc), o intervalo entre o ápice e o final da onda T (TpTe) e identificados os respectivos valores mínimos, máximos e médios nas 12 derivações do eletrocardiograma. Foram calculados também as dispersões dos intervalos QT (DQT) e QTc (DQTc). Resultados: Em 12 meses de acompanhamento clínico, nove sujeitos foram submetidos a transplante hepático (Child A: 0 (0%); Child B: 6 (23,1%); Child C: 3 (18,8%); p=0,04) e 12 faleceram (Child A: 3 (12,0%); Child B: 4 (15,4%); Child C: 5 (31,3%); p=0,002). Não foram observadas diferenças significativas entre os grupos cirróticos relacionadas aos valores mínimos, máximos e médios dos intervalos QT, QTc, TpTe, DQT e DQTc. O intervalo TpTe mínimo ≤50ms foi preditor de desfecho composto de óbito ou transplante hepático com sensibilidade de 90% e especificidade de 57% (p=0,005). Na análise multivariada de Cox, grupos Child e TpTe mínimo ≤50ms foram preditores independentes de desfechos compostos. Conclusão: Os intervalos QT, QTc, DQT, DQTc e TpTe apresentam distribuições semelhantes entre diferentes estágios de gravidade da doença cirrótica. O intervalo TpTe mostra-se marcador prognóstico em sujeitos cirróticos, independente da gravidade da doença. (NCT01433848).
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Disfunção Ventricular/fisiopatologia , Cirrose Hepática/fisiopatologia , Prognóstico , Valores de Referência , Fatores de Tempo , Índice de Gravidade de Doença , Biomarcadores , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Análise de Variância , Fatores Etários , Disfunção Ventricular/mortalidade , Estatísticas não Paramétricas , Eletrocardiografia , Cirrose Hepática/mortalidadeRESUMO
BACKGROUND: There is still debate about the relationship between changes in ventricular repolarization on the surface electrocardiogram and cirrhosis severity. OBJECTIVE: To study the relationship between variables related to ventricular repolarization and the clinical severity of the cirrhotic disease. METHODS: We selected 79 individuals with hepatic cirrhosis, classified according to the Child-Pugh-Turcotte criteria (Child A, B, and C). We measured the QT and corrected QT (QTc) intervals, and the interval between the peak and the end of the T wave (TpTe), and we identified their minimum, maximum, and mean values in the 12-lead electrocardiogram. We also calculated the dispersion of the QT (DQT) and QTc (DQTc) intervals. RESULTS: In 12 months of clinical follow-up, nine subjects underwent hepatic transplantation (Child A: 0 [0%]; Child B: 6 [23.1%]; Child C: 3 [18.8%]; p = 0.04) and 12 died (Child A: 3 [12.0%]; Child B: 4 [15.4%]; Child C: 5 [31.3%]; p = 0.002). No significant differences were observed between the cirrhotic groups related to the minimum, maximum, and mean values for the QT, QTc, TpTe, DQT, and DQTc intervals. A minimum TpTe interval ≤ 50 ms was a predictor for the composite endpoints of death or liver transplantation with a sensitivity of 90% and a specificity of 57% (p = 0.005). In the Cox multivariate analysis, the Child groups and a minimum TpTe of ≤ 50 ms were independent predictors of the composite endpoints. CONCLUSION: The intervals QT, QTc, DQT, DQTc, and TpTe have similar distributions between different severity stages in cirrhotic disease. The TpTe interval proved to be a prognostic marker in subjects with cirrhosis, regardless of disease severity (NCT01433848).
