318
out that Gasser et al cite their reference 1 incorrectly; this refers to our report3 demonstrating the cultivation of B burgdorferi of the myocardium in a patient with dilated cardiomyopathy, which had not been reported before.
point
Department of Cardiology, University Clinic of Internal Medicine II, A-1090 Vienna, Austria, and Hygiene Institute, University of Vienna
JUTTA BERGLER-KLEIN DIETMAR GLOGAR GEROLD STANEK
G, Klein J, Bittner R, Glogar D. Borrelia burgdorferi as an etiologic agent in Scand J Infect Dis 1991; 77 (suppl): 85-87. 2. Klein J, Stanek G, Wenzel J, Ullrich R, Glogar D. Evidence of Lyme borreliosis in acute myocarditis and dilated cardiomyopathy: an endomyocardial biopsy study. Eur Heart J 1991; 12 (suppl): 228. 3. Stanek G, Klein J, Bittner R, Glogar D. Isolation of Borrelia burgdorfen from the myocardium of a patient with longstanding cardiomyopathy. N Engl J Med 1990; 1. Stanek
chronic heart failure.
322: 249-52. 4. Klein J, Stanek G, Bittner R, Horvat R, Holzinger C,
Glogar D. Lyme borreliosis as a of myocarditis and heart muscle disease. Eur Heart J 1991; 12 (suppl D): 73-75. 5. Rahn DW, Malawista SE. Lyme disease: recommendations for diagnosis and treatment. Ann Intern Med 1991; 114: 472-81. cause
Autonomic neuropathy and prolongation of QT-interval in liver disease SIR,-Dr Hendrickse and colleagues (June 13, p 1462) show that vagal neuropathy in chronic liver disease is associated with high mortality. The explanation for increased death rate is unknown. Prolongation of the corrected QT (QTc) interval has been reported in diabetic autonomic neuropathy and seems to be an important risk factor for death.1-3 No such data are available for liver diseases. As part of a previous study,4 we examined autonomic function and QTc-interval in patients with alcoholic and non-alcoholic liver diseases. We classified 163 chronic alcoholics into three groups: 32 without liver disease, 48 with fatty liver, and 83 with alcohol-related cirrhosis. We also examined 49 non-alcoholics-14 with primary biliary cirrhosis, 21 with HBsAg-positive chronic liver diseases, and 14 with cirrhosis of other origin-and 85 healthy controls. Parasympathetic function was evaluated by heart rate variation during deep breathing, standing (30/15 ratio), and Valsalva manoeuvre; sympathetic function was assessed by blood pressure response to standing and to the sustained handgrip test.5 QT was determined with Bazett’s formula.2,6 The mean value of five subsequent sinus-beats was calculated. Abnormal QTc-interval ( > 440 ms) was seen significantly more often in patients with autonomic neuropathy than in those with normal autonomic function in all three alcoholic groups (p < 0’001) as well as in non-alcoholics (p
out that Gasser et al cite their reference 1 incorrectly; this refers to our report3 demonstrating the cultivation of B burgdorferi of the myocardium in a patient with dilated cardiomyopathy, which had not been reported before.
point
Department of Cardiology, University Clinic of Internal Medicine II, A-1090 Vienna, Austria, and Hygiene Institute, University of Vienna
JUTTA BERGLER-KLEIN DIETMAR GLOGAR GEROLD STANEK
G, Klein J, Bittner R, Glogar D. Borrelia burgdorferi as an etiologic agent in Scand J Infect Dis 1991; 77 (suppl): 85-87. 2. Klein J, Stanek G, Wenzel J, Ullrich R, Glogar D. Evidence of Lyme borreliosis in acute myocarditis and dilated cardiomyopathy: an endomyocardial biopsy study. Eur Heart J 1991; 12 (suppl): 228. 3. Stanek G, Klein J, Bittner R, Glogar D. Isolation of Borrelia burgdorfen from the myocardium of a patient with longstanding cardiomyopathy. N Engl J Med 1990; 1. Stanek
chronic heart failure.
322: 249-52. 4. Klein J, Stanek G, Bittner R, Horvat R, Holzinger C,
Glogar D. Lyme borreliosis as a of myocarditis and heart muscle disease. Eur Heart J 1991; 12 (suppl D): 73-75. 5. Rahn DW, Malawista SE. Lyme disease: recommendations for diagnosis and treatment. Ann Intern Med 1991; 114: 472-81. cause
Autonomic neuropathy and prolongation of QT-interval in liver disease SIR,-Dr Hendrickse and colleagues (June 13, p 1462) show that vagal neuropathy in chronic liver disease is associated with high mortality. The explanation for increased death rate is unknown. Prolongation of the corrected QT (QTc) interval has been reported in diabetic autonomic neuropathy and seems to be an important risk factor for death.1-3 No such data are available for liver diseases. As part of a previous study,4 we examined autonomic function and QTc-interval in patients with alcoholic and non-alcoholic liver diseases. We classified 163 chronic alcoholics into three groups: 32 without liver disease, 48 with fatty liver, and 83 with alcohol-related cirrhosis. We also examined 49 non-alcoholics-14 with primary biliary cirrhosis, 21 with HBsAg-positive chronic liver diseases, and 14 with cirrhosis of other origin-and 85 healthy controls. Parasympathetic function was evaluated by heart rate variation during deep breathing, standing (30/15 ratio), and Valsalva manoeuvre; sympathetic function was assessed by blood pressure response to standing and to the sustained handgrip test.5 QT was determined with Bazett’s formula.2,6 The mean value of five subsequent sinus-beats was calculated. Abnormal QTc-interval ( > 440 ms) was seen significantly more often in patients with autonomic neuropathy than in those with normal autonomic function in all three alcoholic groups (p < 0’001) as well as in non-alcoholics (p
