title: Diastolic and autonomic dysfunction in early cirrhosis: a dobutamine stress study.
abstract: OBJECTIVE. Presence of cardiac dysfunction in patients with advanced cirrhosis is widely accepted, but data in early stages of cirrhosis are limited. Systolic and diastolic functions, dynamics of QT-interval, and pro-atrial natriuretic peptide (pro-ANP) are investigated in patients with early stage cirrhosis during maximal β-adrenergic drive. MATERIAL AND METHODS. Nineteen patients with Child A (n = 12) and Child B cirrhosis (n = 7) and seven matched controls were studied during cardiac stress induced by increasing dosages of dobutamine and atropine. RESULTS. Pharmacological responsiveness was similar in cirrhosis and controls and the heart rate (HR) increased by 66 ± 15 versus 67 ± 8 min(-1). HR-blood pressure product increased equally by 115% in both cirrhotic patients and controls. However, time to resume HR of 100 beats/min was significantly longer in cirrhosis, p < 0.01. The QTc interval increased after dobutamine infusion in cirrhosis (0.41 ± 0.02 vs. 0.43 ± 0.02 s, p = 0.001) but similar electrophysiological changes were seen in controls. Cardiac volumes increased with the severity of disease. The increased cardiac output was primarily attributed to increased stroke volume. The ejection fraction was similar in patients and controls. Peak filling rate was longer in cirrhosis compared to controls (1.8 ± 0.4 and 1.4 ± 0.2 end-diastolic volume/s, p < 0.01). Pro-ANP was higher in cirrhosis and increased during stress by 13% compared to 0% in controls, p < 0.01. CONCLUSIONS. These findings indicate that patients with early stage cirrhosis exhibit early diastolic and autonomic dysfunction as well as elevated pro-ANP. However, the cardiac chronotropic and inotropic responses to dobutamine stress were normal. The dynamics of ventricular repolarization appears normal in patients with early stage cirrhosis.
authors: Department of Gastroenterology, Odense University Hospital , Odense , Denmark.
authors: Emilie Kristine
authors: EK
authors: Dahl
authors: Søren
authors: S
authors: Møller
authors: Andreas
authors: A
authors: Kjær
authors: Claus Leth
authors: CL
authors: Petersen
authors: Flemming
authors: F
authors: Bendtsen
authors: Aleksander
authors: A
authors: Krag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D001285:Atropine; D001341:Autonomic Nervous System / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002302:Cardiac Output / Q000502:physiology; D016022:Case-Control Studies; D018450:Disease Progression; D004280:Dobutamine; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D010276:Parasympatholytics; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000502:physiology; D013566:Sympathomimetics; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010276:Parasympatholytics; D013566:Sympathomimetics; D004280:Dobutamine; D001285:Atropine; D009320:Atrial Natriuretic Factor