Effect of chronic β-blockade on QT interval in patients with liver cirrhosis

Background/Aims: QT interval prolongation is frequent in cirrhosis, predicts a poor prognosis and may trigger severe ventricular arrhythmias. Our aim was to evaluate the effect of chronic beta-blockade on QT prolongation. Methods: Clinical and laboratory evaluation, ECG and hepatic vein pressure gradient (HVPG) measurement were performed in 30 cirrhotic patients before and 1-3 months after prophylactic nadolol. QT was corrected for heart rate by the cirrhosis-specific formula and other formulas. Results: QT(cirrhosis) was prolonged in 10 patients (33%); HVPG was increased in all cases. QTcirrhosis was correlated with the Child-Pugh score (r = 0.40; p = 0.027). Nadolol shortened QT interval only with the Bazett formula (p = 0.01), remaining unchanged with the other formulas. The QT interval shortened only if prolonged at baseline (from 473.3 +/- 5.5 to 458.4 +/- 6.5 ms; p = 0.007), while it lengthened when normal (from 429.8 +/- 3.1 to 439.3 +/- 2.9 ms; p = 0.01). QTc changes were directly related to the baseline value (p < 0.001). HVPG decreased from 19.4 +/- 0.8 to 15.6 +/- 1.3 mmHg (p = 0.004). The HVPG changes did not correlate with QTc changes. Conclusions: Chronic P-blockade shortens the QT interval only in patients with prolonged baseline values, and this is likely due to a direct cardiac effect. (C) 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.