Elsevier

Journal of Hepatology

Volume 31, Issue 4, October 1999, Pages 712-718
Journal of Hepatology

Increased arterial compliance in decompensated cirrhosis

https://doi.org/10.1016/S0168-8278(99)80352-3Get rights and content

Abstract

Background/Aims: In patients with cirrhosis, the systemic circulation is hyperdynamic with low arterial blood pressure and reduced systemic vascular resistance. The present study was undertaken to estimate the compliance of the arterial tree in relation to severity of cirrhosis, circulating level of the vasodilator, calcitonin gene-related peptide (CGRP) and mean arterial blood pressure (MAP).

Methods: Arterial compliance (COMPart=ΔV/ΔP) was determined as the stroke volume relative to pulse pressure (i.e. systolic minus diastolic blood pressure) during a haemodynamic evaluation of portal hypertension in patients with biopsy-verified cirrhosis (Child-Turcotte classes A/B/C=10/15/6).

Results: COMPart was significantly higher in cirrhotic patients (n=31) than in controls (n=10) (1.44 vs 1.00·10−3 l/mm Hg, p<0.01). It increased significantly through the Child-Turcotte classes A, B, and C (1.02, 1.47, and 2.1 · 10−3 l/mmHg, respectively, p=0.03). The stroke volume did not change significantly with the severity of the disease, but pulse pressure decreased through class A, B, and C (79, 65, and 50 mm Hg, respectively, p<0.01). COMPart was slightly, but significantly correlated to the circulating level of CGRP (r=0.34, p<0.05), and a substantial but inverse correlation was present to MAP (r=−0.63, p<0.002).

Conclusions: Elevated arterial compliance in cirrhosis is directly related to the severity of the disease and to the elevated level of circulating vasodilator peptide CGRP, and inversely related to the level of arterial blood pressure. The altered static and dynamic functions of the arterial wall in cirrhosis may have implications for the circulatory and homoeostatic derangement, and potentially for therapy with vasoactive drugs.

Section snippets

Study population

The study population comprised 31 patients with cirrhosis referred for haemodynamic investigation in order to diagnose and quantify portal hypertension. All patients had biopsy-verified cirrhosis. The age range was 30–74 years, with an average age of 53 years. None of the patients had experienced recent gastrointestinal bleeding, had signs of alcoholic hepatitis, or had encephalopathy above grade I. All patients had abstained from alcohol for at least 1 week and had no withdrawal symptoms at

Results

The results of the haemodynamic measurements are summarised in Table 2. SVR decreased significantly through the Child-Turcotte classes (p=0.04). Both SBP and DBP decreased significantly with increasing severity of the disease (p=0.002 and p=0.025). As expected, wedged-to-free hepatic venous pressure was substantially elevated and increased somewhat with the severity of the disease.

SV was significantly higher in the patients with cirrhosis than in the controls (86±4.4 vs 71±4.7 ml, p<0.05), but

Discussion

The present study shows that compliance of the arterial tree is elevated in patients with cirrhosis. COMPart increases, whereas the pulse amplitude decreases, with increasing severity of cirrhosis. The COMPart is slightly but significantly related to the elevated circulating levels of the vasodilator peptide CGRP, and inversely related to the level of arterial blood pressure.

The concept of arterial compliance is complex 26., 27., 31., 32.. Thus, the static and dynamic wall characteristics of

Acknowledgements

This study was supported by The John and Birthe Meyer Foundation, The Tode Foundation and a research grant by the H:S (Copenhagen Hospital Corporation) Research Foundation.

The authors are grateful to Ms Hanne B. Hansen, Master of Science, for skilful handling of the database and to Ms Bente Henriksen, secretary, for typing the manuscript.

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