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Effects of tilting on central hemodynamics and homeostatic mechanisms in cirrhosis
Author(s) -
Møller Søren,
Nørgaard Annette,
Henriksen Jens H.,
Frandsen Erik,
Bendtsen Flemming
Publication year - 2004
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.1840400410
Subject(s) - hyperdynamic circulation , medicine , supine position , cirrhosis , hemodynamics , blood volume , blood pressure , plasma renin activity , cardiology , vascular resistance , hypovolemia , anesthesia , renin–angiotensin system
Patients with cirrhosis have a hyperdynamic circulation and an abnormal blood volume distribution with central hypovolemia, an activated sympathetic nervous system (SNS) as well as the renin‐angiotensin‐aldosterone system (RAAS). As the hyperdynamic circulation in cirrhosis may be present only in the supine patient, we studied the humoral and central hemodynamic responses to changes with posture. Twenty‐three patients with alcoholic cirrhosis (Child‐Turcotte‐Pugh classes A/B/C: 2/13/8) and 14 healthy controls were entered. Measurements of central hemodynamics and activation of SNS and RAAS were taken in the supine position, after 30° head‐down tilting, and after 60° passive head‐up tilting for a maximum of 20 minutes. After the head‐up tilting, the central blood volume (CBV) decreased in both groups, but the decrease was significantly smaller in patients than in controls (−19% vs. −36%, P < .01). Central circulation time increased only in the patients (+30% vs. −1%, P < .01). The absolute increases in circulating norepinephrine and renin after head‐up tilting were significantly higher in the patients than in the controls ( P < .05 and P < .01, respectively). In patients with cirrhosis, changes in SNS and RAAS were related to changes in arterial blood pressure, systemic vascular resistance, heart rate, non‐CBV, plasma volume, and arterial compliance. In conclusion, cardiovascular and humoral responses to changes in posture are clearly abnormal in patients with cirrhosis. Head‐up tilting decreases the CBV less in patients with cirrhosis, and the results suggest a differential regulation of central hemodynamics in patients with cirrhosis. (Hepatology 2004;40:811–819).