title: Differential visceral blood flow in the hyperdynamic circulation of patients with liver cirrhosis.
abstract: BACKGROUND
  With advancing liver disease and the development of portal hypertension, there are major alterations in somatic and visceral blood flow. Using phase-contrast magnetic resonance angiography, we characterised alterations in blood flow within the hepatic, splanchnic and extra-splanchnic circulations of patients with established liver cirrhosis.
  
  
  OBJECTIVE
  To compare blood flow in splanchnic and extra-splanchnic circulations in patients with varying degrees of cirrhosis and healthy controls.
  
  
  METHODS
  In a single-centre prospective study, 21 healthy volunteers and 19 patients with established liver disease (Child's stage B and C) underwent electrocardiogram-gated phase-contrast-enhanced 3T magnetic resonance angiography of the aorta, hepatic artery, portal vein, superior mesenteric artery, and the renal and common carotid arteries.
  
  
  RESULTS
  In comparison to healthy volunteers, resting blood flow in the descending thoracic aorta was increased by 43% in patients with liver disease (4.31 ± 1.47 vs. 3.31 ± 0.80 L/min, P = 0.011). While portal vein flow was similar (0.83 ± 0.38 vs. 0.77 ± 0.35 L/min, P = 0.649), hepatic artery flow doubled (0.50 ± 0.46 vs. 0.25 ± 0.15 L/min, P = 0.021) and consequently total liver blood flow increased by 30% (1.33 ± 0.84 vs. 1.027 ± 0.5 L/min, P = 0.043). In patients with liver disease, superior mesenteric artery flow was threefold higher (0.65 ± 0.35 vs. 0.22 ± 0.13 L/min, P < 0.001), while total renal blood flow was reduced by 40% (0.37 ± 0.14 vs. 0.62 ± 0.22 L/min, P < 0.001) and total carotid blood flow unchanged (0.62 ± 0.20 vs. 0.65 ± 0.13 L/min, P = 0.315).
  
  
  CONCLUSIONS
  Rather than a generalised systemic hyperdynamic circulation, liver disease is associated with dysregulated splanchnic vasodilatation and portosystemic shunting that, while inducing a high cardiac output, causes compensatory extra-splanchnic vasoconstriction - the 'splanchnic steal' phenomenon. These circulatory disturbances may underlie many of the manifestations of advanced liver disease.
authors.affiliation: Department of Hepatology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: McAvoy
authors.affiliation: Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK.|Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: S
authors.initials: S
authors.lastname: Semple
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.|Clinical Surgery, University of Edinburgh, Edinburgh, UK.
authors.forename: J M J
authors.initials: JM
authors.lastname: Richards
authors.affiliation: Clinical Surgery, University of Edinburgh, Edinburgh, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Robson
authors.affiliation: Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK.|Department of Radiology, Royal infirmary of Edinburgh, Edinburgh, UK.
authors.forename: D
authors.initials: D
authors.lastname: Patel
authors.affiliation: Medical School, University of Edinburgh, Edinburgh, UK.
authors.forename: A G M
authors.initials: AG
authors.lastname: Jardine
authors.affiliation: Medical School, University of Edinburgh, Edinburgh, UK.
authors.forename: K
authors.initials: K
authors.lastname: Leyland
authors.affiliation: Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Cooper
authors.affiliation: Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK.|Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: D E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: Department of Hepatology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: P C
authors.initials: PC
authors.lastname: Hayes
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000502:physiology; D011446:Prospective Studies; D013152:Splanchnic Circulation / Q000502:physiology*