Effects of tilting on central hemodynamics and homeostatic mechanisms in cirrhosis

Søren Møller, Annette Nørgaard, Jens H Henriksen, Erik Frandsen, Flemming Bendtsen

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Abstract

Patients with cirrhosis have a hyperdynamic circulation and an abnormal blood volume distribution with central hypovolemia, an activated sympathetic nervous system (SNS) as well as the renin-angiotensin-aldosterone system (RAAS). As the hyperdynamic circulation in cirrhosis may be present only in the supine patient, we studied the humoral and central hemodynamic responses to changes with posture. Twenty-three patients with alcoholic cirrhosis (Child-Turcotte-Pugh classes A/B/C: 2/13/8) and 14 healthy controls were entered. Measurements of central hemodynamics and activation of SNS and RAAS were taken in the supine position, after 30 degrees head-down tilting, and after 60 degrees passive head-up tilting for a maximum of 20 minutes. After the head-up tilting, the central blood volume (CBV) decreased in both groups, but the decrease was significantly smaller in patients than in controls (-19% vs. -36%, P <.01). Central circulation time increased only in the patients (+30% vs. -1%, P <.01). The absolute increases in circulating norepinephrine and renin after head-up tilting were significantly higher in the patients than in the controls (P <.05 and P <.01, respectively). In patients with cirrhosis, changes in SNS and RAAS were related to changes in arterial blood pressure, systemic vascular resistance, heart rate, non-CBV, plasma volume, and arterial compliance. In conclusion, cardiovascular and humoral responses to changes in posture are clearly abnormal in patients with cirrhosis. Head-up tilting decreases the CBV less in patients with cirrhosis, and the results suggest a differential regulation of central hemodynamics in patients with cirrhosis.
Original languageEnglish
JournalHepatology
Volume40
Issue number4
Pages (from-to)811-9
Number of pages8
ISSN0270-9139
DOIs
Publication statusPublished - 2004

Bibliographical note

Keywords: Adult; Atrial Natriuretic Factor; Blood Pressure; Calcitonin Gene-Related Peptide; Compliance; Female; Head-Down Tilt; Heart Rate; Hemodynamics; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Norepinephrine; Plasma Volume; Posture; Renin; Vascular Resistance

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