Key result
QTc > 500 ms linked to ~24% higher 30-day MACE risk after liver transplantation.
Why the study?
The proportional increase of QTc along ESLD severity may cause inconsistent outcome reporting when using conventional prolonged QTc thresholds.
Does a QTc interval > 500 ms predict 30-day major adverse cardiovascular events in patients with end-stage liver disease undergoing liver transplantation?
Cohort (n=2,579)
Does a QTc interval > 500 ms predict 30-day major adverse cardiovascular events in patients with end-stage liver disease undergoing liver transplantation?
Effect estimate: OR 1.24 (95% CI 1.06-1.46)
Absolute Event Rate: 20.1% vs 12.5%
p-value: p=0.007
In patients with end-stage liver disease undergoing liver transplantation, a QTc > 500 ms, but not the conventional prolonged QTc threshold, is associated with an increased risk of 30-day major adverse cardiovascular events.
QTc >500 ms may flag higher 30-day MACE risk after liver transplant; hypothesis-generating and requires prospective validation before guiding risk stratification.
BACKGROUND AND AIM: The proportional increase of corrected QT interval (QTc) along end-stage liver disease (ESLD) severity may lead to inconsistent outcome reporting if based on conventional threshold of prolonged QTc. We investigated the comprehensive QTc distribution among ESLD patients and assessed the association between QTc > 500 ms, a criterion for diagnosing severe long-QT syndrome, and the 30-day major adverse cardiovascular event (MACE) after liver transplantation (LT) and identified the risk factors for developing QTc > 500 ms. METHODS: Data were collected prospectively from the Asan LT Registry between 2011 and 2018, and outcomes were retrospectively reviewed. Multivariable analysis and propensity score-weighted adjusted odds ratios (ORs) were calculated. Thirty-day MACEs were defined as the composite of cardiovascular mortality, arrhythmias, myocardial infarction, pulmonary thromboembolism, and/or stroke. RESULTS: Of 2579 patients, 194 (7.5%) had QTc > 500 ms (QTc500_Group), and 1105 (42.8%) had prolonged QTc (QTcP_Group), defined as QTc > 470 ms for women and >450 ms for men. The 30-day MACE occurred in 336 (13%) patients. QTc500_Group showed higher 30-day MACE than did those without (20.1% vs 12.5%, P = 0.003), with corresponding adjusted OR of 1.24 (95% CI: 1.06-1.46, P = 0.007). However, QTcP_Group showed comparable 30-day MACE (13.3% vs 12.8% without prolonged QTc, P = 0.764). Significant risk factors for QTc > 500 ms development were advanced liver disease, female sex, hypokalemia, hypocalcemia, high left ventricular end-diastolic volume, and tachycardia. CONCLUSION: Our results revealed that, among ESLD patients, a novel threshold of QTc > 500 ms was associated with post-LT 30-day MACE but not with conventional threshold, indicating that a longer QTc threshold should be considered for this unique patient population.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2020) conducted a cohort in End-stage liver disease undergoing liver transplantation (n=2,579). QTc > 500 ms vs. QTc ≤ 500 ms was evaluated on 30-day major adverse cardiovascular event (MACE) (composite of cardiovascular mortality, arrhythmias, myocardial infarction, pulmonary thromboembolism, and/or stroke) (OR 1.24, 95% CI 1.06-1.46, p=0.007). A markedly prolonged QTc interval > 500 ms was associated with a higher risk of 30-day MACE after liver transplantation compared to those without (OR 1.24; 95% CI 1.06-1.46; P=0.007).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: