Open Access Research article

Prevalence of pre-transplant electrocardiographic abnormalities and post-transplant cardiac events in patients with liver cirrhosis

Axel Josefsson14*, Michael Fu1, Einar Björnsson2 and Evangelos Kalaitzakis13

Author Affiliations

1 Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

2 Department of Internal Medicine, The National University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland

3 Department of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden

4 Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Göteborg, Sweden

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BMC Gastroenterology 2014, 14:65  doi:10.1186/1471-230X-14-65

Published: 5 April 2014



Although cardiovascular disease is thouht to be common in cirrhosis, there are no systematic investigations on the prevalence of electrocardiographic (ECG) abnormalities in these patients and data on the occurrence of post-transplant cardiac events in comparison with the general population are lacking. We aimed to study the prevalence and predictors of ECG abnormalities in patients with cirrhosis undergoing liver transplantation and to define the risk of cardiac events post-transplant compared to the general population.


Cirrhotic patients undergoing first-time liver transplantation between 1999–2007 were retrospectively enrolled. ECGs at pre-transplant evaluation were reviewed using the Minnesota classification and compared to healthy controls. Standardized incidence ratios for post-transplant cardiac events were calculated.


234 patients with cirrhosis were included, 186 with an available ECG (36% with alcoholic and 24% with viral cirrhosis; mean follow-up 4 years). Cirrhotics had a prolonged QTc interval, a Q wave, abnormal QRS axis deviation, ST segment depression and a pathologic T wave more frequently compared to controls (p < 0.05 for all). Arterial hypertension, older age, cirrhosis severity and etiology were related to ECG abnormalities. Compared to the general Swedish population, patients were 14 times more likely to suffer a cardiac event post-transplant (p < 0.001). A prolonged QTc interval and Q wave were related to post-transplant cardiac events (p < 0.05 for all).


Pre-transplant ECG abnormalities are common in cirrhosis and are associated with cardiovascular risk factors and cirrhosis severity and etiology. Post-transplant cardiac events are more common than in the general population.

Electrocardiography; Liver cirrhosis; Liver transplantation; Cardiac events