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Total effective vascular compliance in patients with cirrhosis: A study of the response to acute blood volume expansion
Author(s) -
Hadengue Antoine,
Moreau Richard,
Gaudin Christophe,
Bacq Yannick,
Champigneulle Bruno,
Lebrec Didier
Publication year - 1992
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840150511
Subject(s) - compliance (psychology) , medicine , blood volume , cardiology , cirrhosis , volume expansion , volume (thermodynamics) , plasma volume , psychology , social psychology , physics , quantum mechanics
Although arterial vasodilation is a well‐known feature in patients with cirrhosis, the venous system remains unexplored. To measure total effective vascular compliance, a reflection of the properties of the venous system, rapid volume expansion (300 ml of a gelatin solution in 3 min) was performed in 23 patients. Eleven patients had compensated cirrhosis (Child‐Pugh grade A or B), and eight had decompensated cirrhosis (Child‐Pugh grade C). Four control patients had mild chronic hepatitis, normal hepatic venous pressure and normal liver architecture. Cardiac index, hepatic venous pressures, hepatic and azygos blood flow and renal plasma flow were measured before and immediately after volume expansion. Right atrial pressure was recorded during volume expansion. This allowed the calculation of total effective vascular compliance, which was higher in patients with decompensated cirrhosis than in those with compensated cirrhosis (4.65 ± 4.21 vs. 1.34 ± 0.63 ml ± mm Hg −1 · kg −1 ; p < 0.05). In response to volume expansion, renal vascular resistance decreased significantly in patients with compensated cirrhosis, but not in those with decompensated cirrhosis (−30% ± 33% vs. +2% ± 23%; p < 0.05). No change was seen in glomerular filtration rate. Systemic oxygen consumption increased in patients with compensated cirrhosis, but not in those patients with decompensated cirrhosis (25% ± 33% vs. −4% ± 9%; p < 0.05). Although in all patients with cirrhosis volume expansion increased central venous pressures, azygos blood flow and the hepatic venous pressure gradient did not change. We conclude that in patients with cirrhosis and severe liver failure, total vascular compliance is elevated and probably accounts for blunted systemic and renal effects of volume expansion. (H EPATOLOGY 1992; 15:809‐815).