Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis

doi:10.1016/0168-8278(95)80286-X

Journal of Hepatology

Volume 22, Issue 3, March 1995, Pages 326-332

https://doi.org/10.1016/0168-8278(95)80286-X Get rights and content

Abstract

Background/Aims: Autonomic and cardiac dysfunction have been reported in patients with cirrhosis. We studied left ventricular and autonomic function in 20 patients with both alcoholic and non-alcoholic cirrhosis.

Methods: Autonomic function was assessed by a standard battery of cardiovascular reflex tests. Supine exercise radionuclide ventriculography was used to assess the cardiac response to exercise.

Results: Exercise capacity was reduced in all patients in association with marked chronotropic incompetence (peak heart rates 120.5±6 bpm). Unlike normal subjects thee was no increase in left ventricular ejection fraction on exercise. Stroke volume increased by 23±6%, mediated by an increase in end-diastolic volume of >20%. Cardiac output was subnormal at maximal exercise, increasing by only 96±14% and 97±11% in alcoholic and non-alcoholic groups respectively. The majority (83%) of our patients had autonomic reflex abnormalities.

Conclusions: Patients with cirrhosis of alcohol and non-alcohol related aetiologies have significantly impaired cardiovascular responses to exercise, which are similar to those of a denervated heart. This may have important clinical implications for the ability of these patients to withstand cardiovascular stress.

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Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis

Abstract

Effect of propanolol. J Hepatol

Gastroenterology

Lancet

Lancet

Clin Endocrinol Metab

Life Sci

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Lancet

The haemodynamic response to exercise in patients with Laennec's cirrhosis

J Clin Invest

The circulatory changes in patients with cirrhosis of the liver at rest and during exercise

Clin Sci

Hyperdynamic circulation in portal hypertensive rat model: a primary factor for maintenance of chronic portal hypertension

Am J Physiol

Pathophysiology of hypotension in patients with fulminant liver failure

Gut

Role of glucagon in splanchnic hyperaemia of chronic portal hypertension

Am J Physiol

Ethanol induced increase in portal blood flow: role of acetate and A1 and A2 adenosine receptors

Am J Physiol

Reduced vascular sensitivity to nor-epinephrine in portal hypertensive rats

Am J Physiol

Vascular reactivity in experimental portal hypertension

Am J Physiol

Blunted pressor response to angiotensin and sympathomimetic amines in bile-duct ligated dogs

Clin Sci

Impairment of autonomic reflexes in cirrhosis

Am J Gastroenterol

Prevalence of clinically occult cardiomyopathy in chronic alcoholism

Am Heart J

Cardiac performance in patients with asymptomatic alcoholic cirrhosis of the liver

Am J Cardiol

Cardiac haemodynamic in alcoholic patients with chronic liver disease and a pre-systolic gallop

J Clin Invest

Surgery and portal hypertension

Clinical comparison of cardiac blood pool visualisation with technetium-99m red cells labelled in vivo and with technetium-99m human serum albumin

J Nucl Med

Exercise graded by heart rate in electrocardiographic testing for angina pectoris

Circulation

Cardiopulmonary exercise testing for evaluation of chronic cardiac failure

Am J Cardiol

Clinical comparison of cardiac blood pool visualisation with technetium-⁹⁹m red cells labelled in vivo and with technetium-⁹⁹m human serum albumin