Increased flow-mediated vasodilation in cirrhotic patients with ascites: relationship with renal resistive index.
BACKGROUND
Peripheral vasodilation is the key factor in the development of hyperdynamic circulation, sodium retention and functional renal failure in patients with cirrhosis. Brachial artery flow-mediated dilation (FMD) after transient vascular occlusion is a non-invasive method to assess the shear stress-induced arterial vasodilation.


OBJECTIVE
To evaluate FMD in cirrhotic patients with and without ascites and to assess the relationship between FMD and intrarenal resistances.


METHODS
Flow-mediated dilation was determined in 32 cirrhotic patients (22 with ascites) and 12 healthy controls and correlated with the intrarenal resistive index (RI) assessed by Doppler exploration.


RESULTS
Basal diameter of the brachial artery was similar in healthy controls and in cirrhotic patients, whereas FMD was significantly higher in patients with cirrhosis and ascites [29.5% (range 10.3-50%)] than in pre-ascitic patients [17.3% (range 2.4-48.5%)] and healthy control subjects [11.6% (range 5.1-17.8%)] (P<0.001). Intrarenal RI was significantly higher in patients with cirrhosis than in healthy subjects, and a direct relationship existed between FMD and intrarenal RI (r=0.66; P<0.00001).


CONCLUSIONS
These findings in vivo demonstrate that cirrhotic patients with ascites have an enhanced shear stress-induced peripheral vasodilation, which is closely related to intrarenal vasoconstriction.
Cazzaniga
Massimo
M
Department of Internal Medicine, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
Salerno
Francesco
F
Visentin
Stefania
S
Cirello
Ilaria
I
Donarini
Cesare
C
Cugno
Massimo
M
D001201:Ascites / Q000503:physiopathology; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D006339:Heart Rate; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008103:Liver Cirrhosis / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000502:physiology*; D012079:Renal Circulation / Q000502:physiology*; D018709:Statistics, Nonparametric; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology*