C-reactive protein and cardiac repolarization in cirrhosis

Introduction : The systolic and diastolic function of the left ventricle and the activation of the autonomic nervous system are main determinants of ventricular repolarisation. Purpose : We conducted an analysis of the association of inflammatory markers with indices of ventricular repolarisation (heart rate, duration of repolarisation period - QTc, dispersion of repolarisation - QTcd) as well as with prognostic scores in patients with alcoholic cirrhosis. A group of patients with chronic coronary disease (CAD) and another group with acute myocardial infarction (AMI) were used for comparison. Results : Procalcitonin correlated positively as tendency with Child-Pugh score in the patient group with alcoholic cirrhosis on therapy. Only WBC showed a trend for association with non-homogenous repolarization in the group of male patients with cirrhosis on therapy. Higher white blood count (WBC) was marginally related to shorter minimal repolarisation periods and with dispersion of repolarisation in AMI. Higher CRP was related as tendency with shorter minimal repolarisation periods, longer maximal repolarisation periods and correlated significantly positively with higher dispersion of repolarisation in AMI. Higher levels of CRP also correlated with prolonged maximal repolarization in stable CAD. Conclusions : The count of white blood cells and procalcitonin are associated with risk of complications in alcoholic cirrhosis. In patients with cirrhosis and infection on therapy, WBC is specific marker of increased dispersion of repolarisation. In contrast to cirrhosis, CRP is associated with the risk of ventricular arrhythmias in stable coronary disease, while both CRP and WBC correlated with repolarisation indices in acute myocardial infarction.