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This Article Full Text Full Text (PDF) All Versions of this Article: 292/6/H2966    most recent 01227.2006v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Møller, S. Articles by Bendtsen, F. Search for Related Content PubMed PubMed Citation Articles by Møller, S. Articles by Bendtsen, F.

Reduced baroreflex sensitivity in alcoholic cirrhosis: relations to hemodynamics and humoral systems

Departments of ¹Clinical Physiology and ²Gastroenterology, Hvidovre Hospital, Hvidovre; and ³Department of Nephology Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Submitted 7 November 2006 ; accepted in final form 8 February 2007

In cirrhosis, arterial vasodilatation leads to central hypovolemia and activation of the sympathetic nervous and renin-angiotensin-aldosterone systems. As the liver disease and circulatory dysfunction may affect baroreflex sensitivity (BRS), we assessed BRS in a large group of patients with cirrhosis and in controls who were all supine and some after 60° passive head-up and 30° head-down tilting in relation to central hemodynamics and activity of the sympathetic nervous and renin-angiotensin-aldosterone systems. One-hundred and five patients (Child classes A/B/C: 21/55/29) and 25 (n = 11 + 14) controls underwent a full hemodynamic investigation. BRS was assessed by cross-spectral analysis of variabilities between blood pressure and heart rate time series. The median BRS was significantly lower in the supine cirrhotic patients, 3.7 (range 0.3–30.7) ms/mmHg than in matched controls (n = 11): 14.3 (6.1–23.6) ms/mmHg, P < 0.001. A stepwise multiple-regression analysis revealed that serum sodium (P = 0.044), heart rate (P = 0.027), and central circulation time (P = 0.034) independently correlated with BRS. Head-down tilting had no effects on BRS, but, after head-up tilting, BRS was similar in the patients (n = 23) and controls (n = 14). In conclusion, BRS is reduced in cirrhosis in the supine position and relates to various aspects of cardiovascular dysfunction, but no further reduction was observed in parallel with the amelioration of the hyperdynamic circulation after head-up tilting. The results indicate that liver dysfunction and compensatory mechanisms to vasodilatation may be involved in the low BRS, which may contribute to poor cardiovascular adaptation in cirrhosis.

cardiovascular dysfunction; central circulation time; hyperdynamic circulation; renin-angiotensin-aldosterone system; sympathetic nervous system

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