Maintained cerebral and skeletal muscle oxygenation during maximal exercise in patients with liver cirrhosis.
OBJECTIVE
In cirrhotic patients, insufficient redistribution of blood from splanchnic organs to the central circulation could limit blood supply to skeletal muscles and the brain during exercise.


METHODS
Eight cirrhotic patients performed incremental cycling to exhaustion (74 (49-123) W; median with range).


RESULTS
Heart rate increased from 68 (62-88)beats/min at rest to 142 (116-163)beats/min, cardiac output from 5.1 (3.3-7.2) to 12.9 (8.5-15.9)l/min, and mean arterial pressure from 89 (75-104) to 115 (92-129)mmHg (P<0.05), while the indocyanine green elimination determined hepatosplanchnic blood flow declined from 0.97 (0.55-1.46) to 0.62 (0.36-1.06)l/min (P<0.05). As assessed by near-infrared spectrophotometry, cerebral oxygenation (NIRS) was 61% (48-85%) and increased to 72% (57-86%) during exercise (P<0.05). The NIRS determined oxygenation of the vastus lateralis muscle also increased: the concentrations of oxygenated haemoglobin by 5.9 (0.57-9.47)micromol/l, deoxygenated haemoglobin by 7.2 (1.8-12.0)micromol/l, and thus total haemoglobin by 12.1 (3.6-21.5)micromol/l (P<0.05).


CONCLUSIONS
In patients with cirrhosis, exercise reduces hepatosplanchnic blood flow, while O(2) supply to muscle and brain appears to increase indicating that blood redistribution from splanchnic organs does not limit blood flow to working muscles and the brain.
Department of Hepatology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København O, Denmark. hbay@vip.cybercity.dk
Henning
H
Bay Nielsen
Niels H
NH
Secher
Otto
O
Clemmesen
Peter
P
Ott
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply / Q000378:metabolism*; D002560:Cerebrovascular Circulation / Q000502:physiology; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008102:Liver Circulation / Q000502:physiology; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000503:physiopathology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000378:metabolism*; D010092:Oximetry; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption / Q000502:physiology; D010108:Oxyhemoglobins / Q000378:metabolism; D019265:Spectroscopy, Near-Infrared
D010108:Oxyhemoglobins; D010100:Oxygen