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

Søren Møller; Jens S Iversen; Jens H Henriksen; Flemming Bendtsen

doi:10.1152/ajpheart.01227.2006

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

Søren Møller, Jens S Iversen, Jens H Henriksen, Flemming Bendtsen

50 Citations (Scopus)

Abstract

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 degrees passive head-up and 30 degrees 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.
Udgivelsesdato: 2007-Jun

Original language	English
Journal	American Journal of Physiology: Heart and Circulatory Physiology
Volume	292
Issue number	6
Pages (from-to)	H2966-72
ISSN	0363-6135
DOIs	https://doi.org/10.1152/ajpheart.01227.2006
Publication status	Published - 2007

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10.1152/ajpheart.01227.2006

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@article{6805f6301ba111df8ed1000ea68e967b,

title = "Reduced baroreflex sensitivity in alcoholic cirrhosis: relations to hemodynamics and humoral systems",

abstract = "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 degrees passive head-up and 30 degrees 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. Udgivelsesdato: 2007-Jun",

author = "S{\o}ren M{\o}ller and Iversen, {Jens S} and Henriksen, {Jens H} and Flemming Bendtsen",

note = "Keywords: Aldosterone; Baroreflex; Blood Pressure; Case-Control Studies; Female; Head-Down Tilt; Heart Rate; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Norepinephrine; Regression Analysis; Renin; Renin-Angiotensin System; Severity of Illness Index; Sodium; Supine Position; Sympathetic Nervous System; Tilt-Table Test; Vasodilation",

year = "2007",

doi = "10.1152/ajpheart.01227.2006",

language = "English",

volume = "292",

pages = "H2966--72",

journal = "American Journal of Physiology - Heart and Circulatory Physiology",

issn = "0363-6135",

publisher = "American Physiological Society",

number = "6",

}

TY - JOUR

T1 - Reduced baroreflex sensitivity in alcoholic cirrhosis: relations to hemodynamics and humoral systems

AU - Møller, Søren

AU - Iversen, Jens S

AU - Henriksen, Jens H

AU - Bendtsen, Flemming

N1 - Keywords: Aldosterone; Baroreflex; Blood Pressure; Case-Control Studies; Female; Head-Down Tilt; Heart Rate; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Norepinephrine; Regression Analysis; Renin; Renin-Angiotensin System; Severity of Illness Index; Sodium; Supine Position; Sympathetic Nervous System; Tilt-Table Test; Vasodilation

PY - 2007

Y1 - 2007

N2 - 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 degrees passive head-up and 30 degrees 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. Udgivelsesdato: 2007-Jun

AB - 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 degrees passive head-up and 30 degrees 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. Udgivelsesdato: 2007-Jun

U2 - 10.1152/ajpheart.01227.2006

DO - 10.1152/ajpheart.01227.2006

M3 - Journal article

C2 - 17293491

SN - 0363-6135

VL - 292

SP - H2966-72

JO - American Journal of Physiology - Heart and Circulatory Physiology

JF - American Journal of Physiology - Heart and Circulatory Physiology

IS - 6

ER -