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Title: Effect of QT Interval Prolongation on Cardiac Arrest following Liver Transplantation and Derivation of a Risk Index.
Austin Authors: Koshy, Anoop N ;Ko, Jefferson ;Farouque, Omar ;Cooray, Shamil D;Han, Hui-Chen ;Cailes, Benjamin ;Gow, Paul J ;Weinberg, Laurence ;Testro, Adam G ;Lim, Han S ;Teh, Andrew W 
Affiliation: Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Parkville, Victoria, Australia
Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Issue Date: 12-Jun-2020 2020-06-12
Publication information: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2020; online first: 12 June
Abstract: Liver transplantation(LT) has a four-fold higher risk of periprocedural cardiac arrest and ventricular arrhythmias(CA/VA) compared with other noncardiac surgeries. Prolongation of the corrected QT interval(QTc) is common in patients with liver cirrhosis. Whether it is associated with an increased risk of CA/VA following LT is unclear. Rates of 30-day CA/VA post-LT was assessed in consecutive adults undergoing LT between 2010-2017. Pre-transplant QTc was measured by a cardiologist blinded to clinical outcomes. Among 408 patients included, CA/VA occurred in 26(6.4%) patients. QTc was significantly longer in CA/VA patients(475±34 vs 450±34 milliseconds, p<0.001). Optimal QTc cut-off for prediction of CA/VA was ≥480ms. After adjustment, QTc≥480ms remained the strongest predictor for the occurrence of CA/VA(Odds ratio[OR] 5.2 95%CI 2.2-12.6). A point-based cardiac arrest risk index(CARI) was derived with the bootstrap method for yielding optimism-corrected coefficients(2-points:QTc ≥480, 1-point:MELD≥30, 1-point:age≥65 and 1-point:male). CARI score≥3 demonstrated moderate discrimination(c-statistic 0.79, optimism-corrected c-statistic 0.77) with appropriate calibration. Conclusion: QTc≥480ms was associated with a five-fold increase in the risk of CA/VA. The CARI score may identify patients at higher risk of these events. Whether heightened perioperative cardiac surveillance, avoidance of QT prolonging medications or beta-blockers could mitigate the risk of CA/VA in this population merits further study.
DOI: 10.1111/ajt.16145
ORCID: 0000-0001-6505-7233
PubMed URL: 32530547
Type: Journal Article
Appears in Collections:Journal articles

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