Small artery compliance in cirrhotic patients during total paracentes.
BACKGROUND
Hemodynamic changes, including systemic vascular resistance, in cirrhotic patients during massive paracentesis have been reported, but large and small artery compliance has not yet been investigated.


OBJECTIVE
To investigate hemodynamic variables, including small and large artery compliance, in cirrhotic patients during total paracentesis.


METHODS
The study included 15 cirrhotic patients admitted for an episode of tense diuretic-resistant ascites. Hemodynamic variables including vascular compliance were measured using an HDI pulse wave cardiovascular profiling instrument CR-2000. The variables were measured in these patients before, immediately after, and 24 hours following large volume (mean 5.6 L) paracentesis.


RESULTS
Cardiac output increased immediately after paracentesis due to increment in stroke volume, with no change in heart rate. However, 24 hours later the cardiac output decreased to below the basal level. The fluctuation was statistically significant (P < 0.05). There was no change in large artery compliance, but small artery compliance increased after paracentesis (P < 0.05) and partially retumed to the basal level after 24 hours. Systemic vascular resistance measurement showed the same pattern of change: vasodilatation occurred during paracentesis and was attenuated 24 hours later.


CONCLUSIONS
Large volume paracentesis with albumin replacement caused an accentuation of the vasodilatation (small but not large artery) already present in these patients. This may be the first sign of enhanced vasodilatation due to large volume paracentesis before the clinical expression of impaired hemodynamics and deterioration of renal function.
Kogan
Jacob
J
Department of Internal Medicine A, Barzilai Medical Center, Ashkelon, Israel. oranim@barzi.health.gov.il
Turkot
Svetlana
S
Golzman
Boris
B
Oren
Shmuel
S
D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D003187:Compliance; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D019152:Paracentesis; D017534:Radial Artery / Q000503:physiopathology*; D013997:Time Factors