Liver Stiffness, Not Fat Liver Content, Predicts the Length of QTc Interval in Patients with Chronic Liver Disease.

IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research and Practice Pub Date : 2019-12-23 eCollection Date: 2019-01-01 DOI:10.1155/2019/6731498
Mattia Bellan, Cristina Rigamonti, Greta Maria Giacomini, Giulio Makmur, Cecilia Marconi, Francesco Nicosia, Antonio Panero, Carla De Benedittis, Michela E Burlone, Rosalba Minisini, Mario Pirisi
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引用次数: 3

Abstract

The severity of fatty liver at ultrasound has been associated with QT length, a finding invoked to explain the excess cardiovascular risk of patients with fatty liver. However, the ability of ultrasound to stage accurately the severity of fatty liver is limited, with fibrosis a major confounder. Here, we aimed to verify the alleged relationship between fat liver content and QT length using a technique apt at discriminating steatosis from fibrosis noninvasively, i.e., transient elastography (TE) with measure of liver stiffness (LS) and controlled attenuation parameter (CAP). A prospectively collected derivation cohort of 349 patients with chronic liver disease (CLD) of any etiology (N = 105 with nonalcoholic fatty liver) was studied to identify clinical, laboratory, and instrumental predictors of the corrected QT interval (QTc) and QTc prolongation, including LS and CAP. The results were validated on a subgroup of patients belonging to the derivation cohort (out of sample validation), as well as on a completely different group of N = 149 subjects with CLD (out of time validation). QTc values were directly related to liver stiffness (LS; ρ = 0.137; p = 0.011), heart rate (HR; ρ = 0.307; p < 0.001), and age (ρ = 0.265; p < 0.001) and were significantly longer in females (p < 0.001). In contrast, QTc was not associated with the value of controlled attenuation parameter (ρ = 0.019; p = 0.718); moreover, no discernible differences in QTc length were noted based on CLD etiology. QTc was prolonged in 24/349 patients (6.9%); age, HR, and LS were independent predictors of QTc prolongation (χ 2 = 23.7, p < 0.001). Furthermore, QTc values (after logarithmic transformation) were predicted by a model including age, gender, HR, and LS (F = 14.1, R 2 = 0.198, p < 0.001). These latter results were validated by both out-of-sample and out-of-time methods. In conclusion, TE findings strongly suggest that among patients with CLD, fibrosis, not steatosis, is a major determinant of QTc length.

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慢性肝病患者QTc间期长短与肝脏僵硬度而非脂肪含量有关
超声显示脂肪肝的严重程度与QT间期长度有关,这一发现被用来解释脂肪肝患者心血管风险过高的原因。然而,超声准确分期脂肪肝严重程度的能力是有限的,纤维化是一个主要的混杂因素。在这里,我们的目的是验证所谓的脂肪肝含量和QT长度之间的关系,使用一种易于区分脂肪变性和纤维化的无创技术,即瞬时弹性成像(TE)与肝脏硬度(LS)和控制衰减参数(CAP)的测量。对349例任何病因的慢性肝病(CLD)患者(N = 105例非酒精性脂肪肝)进行前瞻性衍生队列研究,以确定校正QT间期(QTc)和QTc延长的临床、实验室和工具预测因素,包括LS和CAP。结果在衍生队列患者亚组中进行验证(样本外验证)。以及完全不同的一组N = 149名CLD受试者(超时验证)。QTc值与肝脏硬度直接相关(LS;ρ = 0.137;p = 0.011),心率(HR;ρ = 0.307;P < 0.001),年龄(ρ = 0.265;P < 0.001),而女性的寿命明显更长(P < 0.001)。相比之下,QTc与控制衰减参数的值无关(ρ = 0.019;P = 0.718);此外,基于CLD病因的QTc长度没有明显差异。24/349例患者(6.9%)QTc延长;年龄、HR、LS是QTc延长的独立预测因子(χ 2 = 23.7, p < 0.001)。此外,QTc值(经过对数变换后)由包括年龄、性别、HR和LS的模型预测(F = 14.1, r2 = 0.198, p < 0.001)。后一种结果被样本外和时间外方法验证。总之,TE结果强烈提示,在CLD患者中,纤维化而非脂肪变性是QTc长度的主要决定因素。
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来源期刊
Gastroenterology Research and Practice
Gastroenterology Research and Practice GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.40
自引率
0.00%
发文量
91
审稿时长
1 months
期刊介绍: Gastroenterology Research and Practice is a peer-reviewed, Open Access journal which publishes original research articles, review articles and clinical studies based on all areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. The journal welcomes submissions on the physiology, pathophysiology, etiology, diagnosis and therapy of gastrointestinal diseases. The aim of the journal is to provide cutting edge research related to the field of gastroenterology, as well as digestive diseases and disorders. Topics of interest include: Management of pancreatic diseases Third space endoscopy Endoscopic resection Therapeutic endoscopy Therapeutic endosonography.
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