# QT Interval Prolongation in Chronic Liver Disease: A Cross-Sectional Study

## TL;DR

This study found that chronic liver disease patients, especially those with cirrhosis, often have prolonged QT intervals and arrhythmias, linked to electrolyte issues and diuretic use.

## Contribution

The study provides new insights into the prevalence and contributing factors of QT prolongation in chronic liver disease patients.

## Key findings

- 38% of CLD patients had prolonged QT intervals, with cirrhotic patients more affected.
- Electrolyte imbalances and diuretic use were strongly associated with QT prolongation and arrhythmias.
- Patients with both QT prolongation and arrhythmias had higher mortality rates.

## Abstract

Background: Chronic liver disease (CLD) is a leading cause of morbidity and mortality worldwide, and its association with cardiovascular complications, particularly QT interval prolongation and arrhythmias, remains underexplored.

Objective: This study aimed to determine the prevalence of QT prolongation and cardiac rhythm disturbances in patients with CLD and to explore contributing factors, including liver disease severity, electrolyte abnormalities, and diuretic use.

Methods: A cross-sectional study was conducted at Warrington Hospital, Warrington, UK, from June 2024 to June 2025. A total of 155 consecutive patients suffering from CLD were added to the study. Demographic, clinical, and laboratory data were collected, and all participants underwent a 12-lead electrocardiogram (ECG) to assess QT interval.

Results: A total of 155 patients with CLD were enrolled in the study, with a mean age of 56.3 ± 12.1 years. Out of these, 60% (n = 93) were male, and 40% (n = 62) were female. Fifty-nine (38%) of patients had prolonged QT intervals, with 29 (45%) of those with cirrhosis showing QT prolongation compared to 30 (19%) in non-cirrhotic patients. Electrolyte imbalances, including hypokalemia (54, 35%) and hypomagnesemia (42, 27%), were more prevalent in patients with prolonged QTc intervals. Arrhythmias were detected in 70 (45%) of patients, with atrial fibrillation being the most common, occurring in 37 (24%). The presence of QT prolongation was significantly associated with an increased incidence of arrhythmias (58% vs. 30%, p = 0.002). Diuretic use was strongly associated with both QT prolongation (p = 0.005) and arrhythmias (p = 0.02). The mortality rate in the study cohort was nine (6%), with higher mortality observed in patients with both QT prolongation and arrhythmias (three, 10%).

Conclusion: QT interval prolongation and cardiac rhythm disturbances are highly prevalent in patients with CLD, especially those with cirrhosis and advanced disease. Electrolyte abnormalities and diuretic use were major contributors to these abnormalities.