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Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites
Author(s) -
Trevisani Franco,
Sica Giuseppe,
Mainquà Paola,
Santese Giuseppina,
De Notariis Stefania,
Caraceni Paolo,
Domenicali Marco,
Zacà Fabio,
Grazi Gian Luca,
Mazziotti Alighieri,
Cavallari Antonino,
Bernardi Mauro
Publication year - 1999
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.510300613
Subject(s) - hyperdynamic circulation , medicine , cardiology , pathogenesis , vascular resistance , cirrhosis , hemodynamics , cardiac index , heart rate , ascites , circulatory system , blood pressure , cardiac output
Patients with advanced cirrhosis frequently show hemodynamic abnormalities. Autonomic dysfunction (AD) is also common and, owing to the importance of autonomic function in cardiovascular homeostasis, it may be involved in the pathogenesis of the hyperdynamic circulation. We, therefore, evaluated the hemodynamic status and autonomic function in 30 patients with cirrhosis, most of them with an advanced stage of the disease. Autonomic function was assessed with 7 cardiovascular tests exploring the vagal or sympathetic function. Each test was scored from 1 to 3 (normal, borderline, altered). Cardiac index (CI) was measured by an echocardiogram. Twenty‐four (80%) patients showed an AD, this being definite in 14 (47%) patients. A vagal dysfunction (VD) was found in 19 patients (63%), this being definite in 11 patients (37%), and a sympathetic dysfunction (SD) in 7 patients (definite in 3 [10%] patients). The patients with AD showed a faster heart rate ( P = .021), lower indicized peripheral vascular resistance ( P = .013), and increased CI ( P = .004) than patients without AD whereas mean arterial pressure did not differ. Similar results were seen by grouping patients according to the VD. AD score was directly correlated with heart rate ( r = 0.53; P = .002) and CI ( r = 0.45; P = .016), and inversely correlated with peripheral vascular resistance ( r = 0.46; P = .013). Even closer correlations were found with vagal score. AD (mainly VD) may be involved in the pathogenesis of the hyperdynamic circulatory syndrome of patients with advanced cirrhosis.