Both a prolonged QT interval and disturbance of auto-such as the congenital long QT syndrome, coronary arnomic nervous system function are markers of poor tery disease, and diabetic autonomic neuropathy. In prognosis in patients with diabetes mellitus and alcopatients with alcohol-related liver disease (ALD) who holic liver disease (ALD). We studied the prevalence of continue to drink to excess, QT prolongation is associabnormal QT interval and autonomic nervous system ated with sudden death. 5 The cause of QT prolongation dysfunction in 53 consecutive patients with end-stage in liver disease is not clear. liver disease before and after orthotopic liver trans-Autonomic nervous dysfunction occurs in patients plantation (OLT). The maximum QT interval in any lead with liver disease; there is a similar frequency between (QT max ) was assessed by two independent observers. The patients with alcohol-and non-alcohol-related liver QT max , corrected for heart rate (QT cmax ) was prolonged damage. 6,7 The presence of autonomic neuropathy in in 44 patients (83%), although increased QT dispersion was not found. There was a significant correlation be-those with chronic liver disease is associated with a tween the QT cmax and Child-Pugh score but not with etipoor prognosis, 8 possibly because of an impaired hemoology. Evidence of parasympathetic dysfunction was static compensatory response to major events such as present in 41 patients (77%), and sympathetic dysfuncgastrointestinal bleeding and sepsis. 6 tion was present in 20 patients before OLT. Fifty-two A relationship between the severity of autonomic patients underwent transplantation. There was signifidamage and extent of the QT corrected for heart rate cant improvement in the QT cmax interval after OLT (P (QT c ) prolongation in ALD and non-ALD has been reΓ΅ .001); 32 of the 44 patients with prolonged QT cmax (ΓΊ440 ported, 9 and it was suggested that autonomic neuropamilliseconds) improved. Repeat testing was not perthy was the cause of the prolonged QT interval.
formed in 7 patients, because they had died or had not
The objectives of this study were (1) to determine undergone transplantation. Indices of parasympathetic function improved in 27 patients after OLT, but no im-the prevalence of abnormal QT interval and autonomic provement was observed in 8. Improvement in sympanervous system dysfunction in transplantation candithetic dysfunction was observed in 13 of the 19 patients dates with end-stage liver disease, and (2) to evaluate tested. There was no association between QT cmax , autoprospectively the effect of orthotopic liver transplantanomic dysfunction, and survival. These results suggest tion (OLT) on QT interval duration and autonomic that both prolonged QT cmax and some tests of autonomic function.
function are temporary and arise as a consequence of liver dysfunction. (HEPATOLOGY 1996;23:1128-1134.) PATIENTS AND METHODS
Patients
The QT interval is an approximate measure of ven-Fifty-five consecutive adult patients with end-stage tricular electrical recovery after excitation. A prolonged chronic liver disease who were referred and subsequently QT interval identifies patients at increased risk for listed for liver transplantation were evaluated. Criteria for sudden cardiac death in a variety of clinical situations, admission to the study included candidates for their first liver graft, age 16 years and over, and the ability to give informed consent. Patients were excluded if they had a history or symptoms of coronary artery disease, significant val-Abbreviations: ALD, alcohol-related liver disease; QTc, QT corrected for vular heart disease, bundle-branch block, or if they were reheart rate; OLT, orthotopic liver transplantation; QTcmax, maximum average QT interval on any lead corrected for heart rate; QTmax, maximum average ceiving therapy that could affect the QT interval. Two QT interval on any lead; bpm, beats per minute; AFT, autonomic function test.