Systemic and regional hemodynamics in pre-ascitic cirrhosis: effects of posture.
OBJECTIVE
To clarify the hemodynamic pattern of pre-ascitic cirrhosis, we compared the impact of posture on systemic and regional hemodynamics of patients and healthy subjects without and with plasma volume expansion.


METHODS
Cardiac index (CI), peripheral vascular resistance (PVRi), heart rate, mean arterial pressure, and the mean blood flow velocities of superior mesenteric (SMAV) and common femoral arteries were evaluated by duplex-Doppler techniques in 10 patients and 20 healthy controls after 2 h of standing and 2 h after lying down. Ten healthy controls received saline infusion (15 ml/kg body weight) when they changed their posture, and five were also evaluated after plasma volume expansion in the upright posture.


RESULTS
Standing systemic and regional hemodynamics did not differ between patients and controls. After saline infusion, standing control subjects showed greater CI and SMAV than patients. Recumbency caused changes of CI, PVRi and SMAV greater in patients and controls with plasma expansion than in controls without expansion, so that supine patients and controls with expansion were indistinguishable, showing higher CI and SMAV and lower PVRi than controls without expansion.


CONCLUSIONS
Systemic and regional hemodynamics of patients with pre-ascitic cirrhosis are mainly determined by blood volume expansion which is compartmentalized within the splanchnic venous bed during standing and translocates towards the central and arterial circulatory districts during recumbency.
Bernardi
Mauro
M
Semeiotica Medica, Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. bernardi@med.unibo.it
Li Bassi
Silvia
S
Arienti
Vincenzo
V
De Collibus
Carlo
C
Scialpi
Cecilia
C
Boriani
Luciana
L
Zanzani
Sara
S
Caraceni
Paolo
P
Trevisani
Franco
F
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000494:pharmacology; D011187:Posture; D012965:Sodium Chloride / Q000494:pharmacology
D010952:Plasma Substitutes; D012965:Sodium Chloride