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Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites

  1. Franco Trevisani1,*,
  2. Giuseppe Sica1,
  3. Paola Mainquà1,
  4. Giuseppina Santese1,
  5. Stefania De Notariis1,
  6. Paolo Caraceni1,
  7. Marco Domenicali1,
  8. Fabio Zacà1,
  9. Gian Luca Grazi2,
  10. Alighieri Mazziotti2,
  11. Antonino Cavallari2,
  12. Mauro Bernardi1

Article first published online: 30 DEC 2003

DOI: 10.1002/hep.510300613

Issue

Hepatology

Hepatology

Volume 30, Issue 6, pages 1387–1392, December 1999

Additional Information

How to Cite

Trevisani, F., Sica, G., Mainquà, P., Santese, G., De Notariis, S., Caraceni, P., Domenicali, M., Zacà, F., Grazi, G. L., Mazziotti, A., Cavallari, A. and Bernardi, M. (1999), Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites. Hepatology, 30: 1387–1392. doi: 10.1002/hep.510300613

Author Information

  1. 1

    Department of Internal Medicine, Cardioangiology and Hepatology, University of Bologna, Italy

  2. 2

    Department of Surgery, Intensive Care and Transplantation, University of Bologna, Italy

*Franco Trevisani, M.D., Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Semeiotica Medica, via Massarenti, 9, 40138 Bologna, Italy. fax: (39) 051 340877

Publication History

  1. Issue published online: 30 DEC 2003
  2. Article first published online: 30 DEC 2003
  3. Manuscript Accepted: 14 SEP 1999
  4. Manuscript Received: 10 FEB 1999

Funded by

  • Ministero dell'Università e della Ricerca Scientifica e Tecnologica (Fondi 60% 1995 and 1996, and Fondi 40% 1998)
  • Tito Fugazza generously furnished essential financial support for this research

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Abstract

Patients with advanced cirrhosis frequently show hemodynamic abnormalities. Autonomic dysfunction (AD) is also common and, owing to the importance of autonomic function in cardiovascular homeostasis, it may be involved in the pathogenesis of the hyperdynamic circulation. We, therefore, evaluated the hemodynamic status and autonomic function in 30 patients with cirrhosis, most of them with an advanced stage of the disease. Autonomic function was assessed with 7 cardiovascular tests exploring the vagal or sympathetic function. Each test was scored from 1 to 3 (normal, borderline, altered). Cardiac index (CI) was measured by an echocardiogram. Twenty-four (80%) patients showed an AD, this being definite in 14 (47%) patients. A vagal dysfunction (VD) was found in 19 patients (63%), this being definite in 11 patients (37%), and a sympathetic dysfunction (SD) in 7 patients (definite in 3 [10%] patients). The patients with AD showed a faster heart rate (P = .021), lower indicized peripheral vascular resistance (P = .013), and increased CI (P = .004) than patients without AD whereas mean arterial pressure did not differ. Similar results were seen by grouping patients according to the VD. AD score was directly correlated with heart rate (r = 0.53; P = .002) and CI (r = 0.45; P = .016), and inversely correlated with peripheral vascular resistance (r = 0.46; P = .013). Even closer correlations were found with vagal score. AD (mainly VD) may be involved in the pathogenesis of the hyperdynamic circulatory syndrome of patients with advanced cirrhosis.

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