Altered cardiovascular responsiveness to active tilting in nonalcoholic cirrhosis.
OBJECTIVE
The hyperdynamic circulation of cirrhosis has been related either to plasma volume expansion (increased preload) or peripheral arterial vasodilation (reduced afterload). The aim of this study was to evaluate cardiovascular function in patients with nonalcoholic cirrhosis by echocardiography.


METHODS
Nineteen patients with abnormal sodium handling (11 sodium excretors and 8 sodium retainers) and 15 healthy volunteers underwent echocardiographic evaluation of left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), cardiac index (CI), mean arterial pressure, and systemic vascular resistance (SVR) during supine resting and after 5 minutes of standing.


RESULTS
Supine patients had increased LVEF and CI and reduced LVESVI and SVR. LVEDVI was increased only in sodium excretors. Standing induced a decrease in LVEDVI in all subjects. Healthy volunteers maintained cardiovascular homeostasis by increasing LVEF and heart rate, whereas cirrhotic patients experienced a decrease in SVI and CI despite marked increments in heart rate, plasma renin activity, and plasma norepinephrine level.


CONCLUSIONS
In patients with cirrhosis, the increased LVEF and reduced LVESVI while in a supine position point at reduced afterload as an important determinant of the hyperdynamic circulation. Evidence of an increased preload secondary to increased blood volume, indicated by a high LVEDVI and increased plasma atrial natriuretic peptide levels, was found only in sodium excretors. The altered response to active tilt in cirrhotic patients suggests an impaired myocardial contractility.
Laffi
G
G
Istituto di Medicina Interna, University of Florence School of Medicine, Italy. g.laffi@mednuc2.unifi.it
Barletta
G
G
La Villa
G
G
Del Bene
R
R
Riccardi
D
D
Ticali
P
P
Melani
L
L
Fantini
F
F
Gentilini
P
P
D000328:Adult; D000368:Aged; D002302:Cardiac Output; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D004702:Endocrine Glands / Q000503:physiopathology; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013318:Stroke Volume; D018667:Tilt-Table Test; D014655:Vascular Resistance