title: Cerebral autoregulation in patients with cirrhosis and ascites. A transcranial Doppler study.
abstract: OBJECTIVE
  Patients with cirrhosis and ascites usually show alterations of systemic hemodynamics and are thus prone to develop arterial hypotension, which might result in cerebral hypoperfusion if cerebral autoregulation is impaired.
  
  
  METHODS
  We evaluated cerebral autoregulation in 15 patients with cirrhosis and ascites and 15 healthy subjects by monitoring mean blood flow velocity in the middle cerebral artery and arterial pressure during supine rest and passive tilting.
  
  
  RESULTS
  Tilt provoked a drop of arterial pressure in both groups. Control subjects had a prompt recovery of mean flow velocity and a progressive recovery of arterial pressure, so that, after 120 s, both parameters had returned to baseline: at 20 s the recovery of flow velocity was faster (p<0.01) than that of blood pressure. By contrast, patients with cirrhosis had a delayed and incomplete recovery of both parameters (p<0.01 vs healthy subjects). In eight patients, the recovery of mean flow velocity paralleled that of arterial pressure, indicating an impaired cerebral autoregulation. These patients had a worse liver function, a higher cardiac index and lower peripheral resistance.
  
  
  CONCLUSIONS
  Cerebral autoregulation is often impaired in patients with cirrhosis and ascites. These patients can develop cerebral hypoperfusion if arterial pressure falls abruptly.
authors.affiliation: Istituto di Medicina Interna, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lagi
authors.forename: G
authors.initials: G
authors.lastname: La Villa
authors.forename: G
authors.initials: G
authors.lastname: Barletta
authors.forename: S
authors.initials: S
authors.lastname: Cencetti
authors.forename: S
authors.initials: S
authors.lastname: Bacalli
authors.forename: M
authors.initials: M
authors.lastname: Cipriani
authors.forename: M
authors.initials: M
authors.lastname: Foschi
authors.forename: C
authors.initials: C
authors.lastname: Lazzeri
authors.forename: R
authors.initials: R
authors.lastname: Del Bene
authors.forename: P
authors.initials: P
authors.lastname: Gentilini
authors.forename: G
authors.initials: G
authors.lastname: Laffi
mesh_terms: D000368:Aged; D001201:Ascites / Q000150:complications / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006706:Homeostasis; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016683:Supine Position; D018667:Tilt-Table Test