Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites

Franco Trevisani, Giuseppe Sica, Paola Mainquà, Giuseppina Santese, Stefania De Notariis, Paolo Caraceni, Marco Domenicali, Fabio Zacà, Gian Luca Grazi, Alighieri Mazziotti, Antonino Cavallari, Mauro Bernardi

Research output: Contribution to journalArticlepeer-review


Patients with advanced cirrhosis frequently show hemodynamic abnormalities. Autonomic dysfunction (AD) is also common and, owing to the importance of autonomic function in cardiovascular homeostasis, it may be involved in the pathogenesis of the hyperdynamic circulation. We, therefore, evaluated the hemodynamic status and autonomic function in 30 patients with cirrhosis, most of them with an advanced stage of the disease. Autonomic function was assessed with 7 cardiovascular tests exploring the vagal or sympathetic function. Each test was scored from 1 to 3 (normal, borderline, altered). Cardiac index (CI) was measured by an echocardiogram. Twenty-four (80%) patients showed an AD, this being definite in 14 (47%) patients. A vagal dysfunction (VD) was found in 19 patients (63%), this being definite in 11 patients (37%), and a sympathetic dysfunction (SD) in 7 patients (definite in 3 [10%] patients). The patients with AD showed a faster heart rate (P = .021), lower indicized peripheral vascular resistance (P = .013), and increased CI (P = .004) than patients without AD whereas mean arterial pressure did not differ. Similar results were seen by grouping patients according to the VD. AD score was directly correlated with heart rate (r = 0.53; P = .002) and CI (r = 0.45; P = .016), and inversely correlated with peripheral vascular resistance (r = 0.46; P = .013). Even closer correlations were found with vagal score. AD (mainly VD) may be involved in the pathogenesis of the hyperdynamic circulatory syndrome of patients with advanced cirrhosis.

Original languageEnglish
Pages (from-to)1387-1392
Number of pages6
Issue number6
Publication statusPublished - 1999

ASJC Scopus subject areas

  • Hepatology


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