Relationship between splanchnic, peripheral and cardiac haemodynamics in liver cirrhosis of different degrees of severity.
OBJECTIVE
To investigate the relationships between changes in splanchnic and systemic haemodynamics in liver cirrhosis.


METHODS
Abdominal and peripheral duplex-Doppler sonography and Doppler echocardiography were performed in 42 cirrhotic patients with (group A, ascitic) or without ascites (group NA, non-ascitic) and in a control group of 36 healthy volunteers.


RESULTS
There were significant differences (P < 0.05 at ANOVA) between the three groups in portal vein flow velocity (controls, groups NA and A, respectively, 29.2, 21.4 and 20.0 cm/s), portal diameter (9.3, 12.2 and 12.0 mm), superior mesenteric artery (SMA) resistance index (RI) (0.889, 0.854 and 0.816), femoral artery RI (0.988, 0.974 and 0.945), mean arterial pressure (MAP) (101.4, 102.0 and 87.3 mmHg), peripheral vascular resistance (1579, 1404 and 1094 dyn/cm5/s) and cardiac index (CI) (2.91, 3.46 and 3.77 l/min/m2). Multiple regression analysis identified renal interlobular- and SMA RI (respectively, r = -0.58 and r = 0.51) in group A as the two regional vascular beds correlated to MAP.


CONCLUSIONS
The deterioration of the cirrhotic hyperdynamic circulation in the presence of ascites and the correlation between MAP and mesenteric and renal resistances are consistent with the peripheral arterial vasodilation hypothesis. The positive correlation between MAP and SMA RI in ascitic patients shows a link between this region and the general circulation. This seems to suggest that splanchnic hyperafflux plays a part in the formation of ascites.
Piscaglia
F
F
Dipartimento di Medicina Interna e Gastroenterologia, Università di Bologna, Italy.
Zironi
G
G
Gaiani
S
S
Ferlito
M
M
Rapezzi
C
C
Siringo
S
S
Gaia
C
C
Gramantieri
L
L
Bolondi
L
L
D000328:Adult; D001794:Blood Pressure; D015150:Echocardiography, Doppler; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006339:Heart Rate; D006439:Hemodynamics; D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000503:physiopathology; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology; D012039:Regional Blood Flow; D012077:Renal Artery / Q000503:physiopathology; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance