Autonomic dysfunction in chronic liver disease

Frith, James; Newton, Julia L.

doi:10.1111/j.1478-3231.2009.01985.x

Cited by 48 publications

(34 citation statements)

References 65 publications

(97 reference statements)

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“…Autonomic dysfunction, typically in the form of vasomotor abnormality, is prevalent in cirrhotic patients with disease of all aetiologies [14] . In the case of PBC, however, it is common at all disease stages and is strongly associated with fatigue [15] .…”

Section: Pathogenesismentioning

confidence: 99%

Fatigue in Primary Biliary Cirrhosis: Prevalence, Pathogenesis and Management

Jopson

Jones

2015

Dig Dis

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Fatigue is a significant problem in approximately 50% of primary biliary cirrhosis (PBC) patients, with 20% of all patients experiencing significant or life-altering fatigue. Large-scale population studies show that fatigue has a major impact on quality of life (QoL) in PBC, and that it disproportionately affects younger patients. The presence of social dysfunction that accompanies fatigue appears to be a major factor in determining whether fatigue of a particular severity impacts on QoL. The pathogenesis of fatigue in PBC remains unclear, although it is unrelated to the severity of underlying disease and is unresponsive to ursodeoxycholic acid. Perhaps, unsurprisingly, it appears to be complex in origin, probably multifactorial in the majority of patients and associated with depression, autonomic dysfunction and sleep disturbance. Clinically, fatigue has both central and peripheral components. The central component is associated with cognitive impairment and sleep disturbance and characterised by neurophysiological abnormalities of activation and facilitation, together with CNS changes. Peripheral fatigue is associated with muscle dysfunction and an inability to sustain exercise. One hypothesis is that the central processes result directly from cholestasis, which impacts autonomic centres in the brain; these processes then regulate peripheral muscle perfusion, leading to systemic peripheral effects. At present, there is no specific drug therapy for fatigue in PBC and no significant improvement following transplantation. In managing patients with fatigue, understanding their situation is crucial and advice regarding pacing and maintaining social interactions is critical. Most important of all is an understanding of the impact this symptom has on patients' lives and an empathetic clinical interaction.

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Section: Pathogenesismentioning

confidence: 99%

Fatigue in Primary Biliary Cirrhosis: Prevalence, Pathogenesis and Management

Jopson

Jones

2015

Dig Dis

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“…Recently, results of mIBG scintigraphy have shown to provide prognostic information, and a clear association has been documented between severity of myocardial neuronal dysfunction and risk of cardiac death (5,8,18). Patients with chronic left ventricular dysfunction are characterized by a significant reduction of presynaptic norepinephrine uptake and reduced postsynaptic ␤-adrenoceptor density together with general increased sympathetic activity in the heart WOR wob (%) 10 Noradrenaline (nmol/l) and in the circulation (5). This corresponds with downregulation of myocardial ␤-adrenoceptor density, which is also seen both experimentally and in patients with cirrhosis (12,22).…”

Section: Discussionmentioning

confidence: 92%

“…liver failure; autonomic dysfunction; single-photon emission computerized tomography; cirrhotic cardiomyopathy; baroreflex sensitivity; sympathetic nervous system; heart rate variability; chronic liver disease; hyperdynamic circulation; cirrhotic cardiomyopathy; autonomic dysfunction; 123 I-metaiodobenzylguanidine AUTONOMIC AND CARDIAC DYSFUNCTION is frequent in cirrhosis and includes impaired baroreflex sensitivity (BRS) and heart rate variability (HRV) in the setting of increased activity of the sympathetic nervous system (SNS) (10,33,41). The recently described, cirrhotic cardiomyopathy is seen in more than 50% of the patients and includes diastolic and systolic dysfunction as well as prolonged QT-interval (29,43).…”

mentioning

confidence: 99%

Cardiac sympathetic imaging withmIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function

Möller¹,

Mortensen

Bendtsen

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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Madsen JL. Cardiac sympathetic imaging with mIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function. Am J Physiol Gastrointest Liver Physiol 303: G1228 -G1235, 2012. First published September 27, 2012 doi:10.1152/ajpgi.00303.2012.-Autonomic and cardiac dysfunction is frequent in cirrhosis and includes increased sympathetic nervous activity, impaired heart rate variability (HRV), and baroreflex sensitivity (BRS). Quantified 123 I-metaiodobenzylguanidine (mIBG) scintigraphy reflects cardiac noradrenaline uptake, and in patients with cardiac failure it predicts outcome. In this study, we aimed to investigate cardiac sympathetic neuronal function in cirrhosis by mIBG scintigraphy in relation to cardiovascular function. Ten patients with alcoholic cirrhosis and 10 age-and sexmatched healthy controls participated in the study. Heart/mediastinum (H/M) ratios of mIBG uptake were calculated 15 and 230 min after intravenous injection of mIBG. Furthermore, washout rate (WOR) of mIBG was calculated. The patients underwent a liver vein catheterization with determination of splanchnic and systemic hemodynamics and measurement of HRV and BRS. mIBG-scintigraphy revealed significantly increased WOR in patients with cirrhosis compared with controls (P Ͻ 0.005), whereas H/M uptakes were equal in the groups. Forty percent of the patients had reduced uptake of mIBG in the infero-lateral segment of the left ventricle. WOR correlated significantly with central circulation time, an estimate of central hypovolemia (r ϭ Ϫ0.64, P Ͻ 0.05) and frequency-corrected QTF interval (r ϭ 0.71, P ϭ 0.01). Patients with cirrhosis had significantly decreased HRV and BRS correlating with indicators of abnormal cathecholamine uptake by mIBG although the catecholamine level was normal in the patients. In conclusion, in alcoholic cirrhosis, mIBG scintigraphy reveals autonomic dysfunction and impaired myocardial distribution of sympathetic nervous activity. It is associated to indicators of central hypovolemia, QT interval, and decreased HRV and BRS. Measurement of myocardial catecholamine uptake by mIBG may add important information on autonomic and cardiac dysfunction in cirrhosis. liver failure; autonomic dysfunction; single-photon emission computerized tomography; cirrhotic cardiomyopathy; baroreflex sensitivity; sympathetic nervous system; heart rate variability; chronic liver disease; hyperdynamic circulation; cirrhotic cardiomyopathy; autonomic dysfunction; 123 I-metaiodobenzylguanidine AUTONOMIC AND CARDIAC DYSFUNCTION is frequent in cirrhosis and includes impaired baroreflex sensitivity (BRS) and heart rate variability (HRV) in the setting of increased activity of the sympathetic nervous system (SNS) (10, 33, 41). The recently described, cirrhotic cardiomyopathy is seen in more than 50% of the patients and includes diastolic and systolic dysfunction as well as prolonged 43). Cirrhotic cardiomyopathy may contribute to development of complications such as renal failure and reduced survival (35). SNS is often activated...

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“…In addition, autonomic dysfunction is frequently seen in patients with various levels of liver disease [53], including early stages [54][55][56][57][58][59], and may manifest as frequent falls, blackouts, orthostatic hypotension, and syncope. It has also been linked to sudden cardiac death and mortality [53].…”

Section: Cardiac and Autonomic Abnormalitiesmentioning

confidence: 99%