Noninvasive assessment of spontaneous baroreflex sensitivity in patients with liver cirrhosis.
OBJECTIVE
An impairment of baroreceptor sensitivity has been found in liver cirrhosis. Noninvasive and spontaneous estimates of baroreflex sensitivity are obtained from beat-to-beat blood pressure and heart rate recordings by means of cross-spectrum analysis and calculation of alpha-index (as a measure of baroreflex gain). The aim of the present study was to investigate the function of the spontaneous baroreflex sensitivity related to clinical Child score in liver cirrhosis.


METHODS
The alpha-index was evaluated in 40 cirrhotic patients (18 with and 22 without ascites) and 17 healthy subjects by analysing finger arterial pressure recorded noninvasively with the Portapres device.


RESULTS
Baroreflex sensitivity was significantly lower in cirrhotic patients with and without ascites compared with healthy subjects (p<0.01). Furthermore, in patients with ascites the baroreflex gain was significantly related to plasma sodium (p<0.01). A significant inverse relationship was present between baroreflex gain and grade of Child score and the severity of ascites (p<0.01). There were no significant relationships between hormonal parameters (catecholamines, renin, aldosterone, arginine-vasopressin, atrial natriuretic peptide and nitric oxide) and baroreflex gain. No significant differences were found between healthy subjects and cirrhotic patients with respect to systolic and diastolic blood pressure total variability in a supine position, whilst it was lower in cirrhotic patients with ascites in a tilted position (p<0.05).


CONCLUSIONS
Our findings showed that baroreflex sensitivity was significantly impaired in cirrhotic patients when compared with healthy subjects. In addition, there was a significant trend toward lower baroreflex sensitivity values with the grade score of Child class (p<0.01). Spectral analysis of the alpha-index provides viable alternatives to the pharmacological approach for estimation of baroreflex sensitivity and may represent a prognostic tool to identify cirrhotic patients at increased risk of adverse events.
Veglio
F
F
Department of Medicine and Experimental Oncology, University of Turin, Italy.
Melchio
R
R
Calva
S
S
Rabbia
F
F
Gallo
V
V
Molino
P
P
Mengozzi
G
G
Mulatero
P
P
Martini
G
G
Riva
P
P
Chiandussi
L
L
D000450:Aldosterone / Q000097:blood; D001127:Arginine Vasopressin / Q000097:blood; D001201:Ascites; D009320:Atrial Natriuretic Factor / Q000097:blood; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000097:blood; D005260:Female; D005583:Fourier Analysis; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D011311:Pressoreceptors / Q000503:physiopathology*; D012083:Renin / Q000097:blood; D012815:Signal Processing, Computer-Assisted; D016683:Supine Position
D002395:Catecholamines; D001127:Arginine Vasopressin; D009569:Nitric Oxide; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D012083:Renin