Flow Mediated Dilation in Cirrhosis: A Pilot Study in Different Stages of the Disease

Armentano, Ricardo L.; Arbeitman, Claudia R.; Cymberknop, Leandro J.; Farro, Ignacio; Viotti, Rodolfo; Cardelino, Juan

doi:10.1109/embc.2018.8513192

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…In patients with portal hypertension, these mechanisms increase cardiac contractility and promote salt and water retention[ 7 ]. When a severe infection ensues, macrovascular[ 8 , 9 ] and microvascular[ 10 ] vasodilatory effects are exaggerated, further decreasing the effective circulating volume and potentiating the neurohumoral response (Figure 1A ).…”

Section: Pathophysiology Of Portal Hypertensionmentioning

confidence: 99%

Emerging concepts in the care of patients with cirrhosis and septic shock

Jiménez¹,

Garcia‐Tsao²,

Saffo³

2023

World J Hepatol

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Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.

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Section: Pathophysiology Of Portal Hypertensionmentioning

confidence: 99%

Emerging concepts in the care of patients with cirrhosis and septic shock

Jiménez¹,

Garcia‐Tsao²,

Saffo³

2023

World J Hepatol

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“…Moreover, several studies have also proposed that endothelial dysfunction may be a significant contributor to the peripheral microvascular changes in patients with cirrhosis. Evidence from initial studies that assessed peripheral endothelial function in vivo with FMD suggested an enhanced vasodilatory response with cirrhosis progression [ 11 , 41 , 47 ]. However, more recently, a number of studies using FMD demonstrated that patients with cirrhosis exhibit impaired endothelium-dependent vasodilation compared with healthy controls, which deteriorates progressively with advanced stages of the disease [ 51 - 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, both in subgroup analyses of the above data, and in several studies that assessed the vascular function with FMD in different stages of cirrhosis, FMD levels were found to be significantly lower in early compared to advanced disease stages, indicating an exaggerated release of endothelial vasodilators, such as NO, with cirrhosis progression ( Fig. 1 ) [ 11 , 41 , 45 , 47 ].…”

Section: Functional Methods Of Endothelial Dysfunction Assessment In ...mentioning

confidence: 95%

Endothelial and microvascular function in liver cirrhosis: an old concept that needs re-evaluation?

Papagiouvanni

Sarafidis

Theodorakopoulou

et al. 2022

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Liver cirrhosis is characterized by significant circulatory dysregulation, related to an imbalance among several vasodilating agents, mainly nitric oxide. In contrast to portal vein and macrovascular hemodynamic alterations, which have been rather well described, the peripheral microcirculatory and endothelial structure and function in this population are less well studied. Endothelial dysfunction is characterized by an imbalance between endothelium-derived relaxing and contracting factors. A number of methods have been used to assess endothelial and microvascular function in human studies. Venous occlusion plethysmography was used for many years as the gold standard for evaluating endothelial function, but flow-mediated dilatation (FMD) of the forearm is currently the most frequently used method. In patients with cirrhosis, the few existing studies have mainly used FMD, but the relevant results are largely contradictory. In recent years, several noninvasive and easily applicable methods, such as near-infrared spectroscopy, laser speckle contrast imaging, peripheral arterial tonometry, optical coherence tomography and nailfold video-capillaroscopy, have been increasingly used to assess peripheral microvascular function and have demonstrated a number of advantages. In this review, we present functional methods to evaluate peripheral microvascular and endothelial function, and we discuss the existing evidence on circulatory dysfunction in patients with liver cirrhosis.

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“…All these methods have boosted research in the field of endothelial and microvascular function in various populations, including patients with cirrhosis 9,12–15 . Among the latter, preliminary studies have shown an enhanced vasodilatory response with cirrhosis progression 9,12,16 ; however, in recent years, several studies suggested that endothelial function was progressively deteriorating toward advanced stages of the cirrhosis, indicating an impaired endothelium‐dependent vasodilation (49–51). On the basis of the above contradictory findings, we conducted for the first time, a systematic review and a meta‐analysis of studies using any functional method to investigate differences between patients with liver cirrhosis and individuals without cirrhosis, in an attempt to shed light in the field.…”

Section: Introductionmentioning

confidence: 99%

Peripheral endothelial and microvascular damage in liver cirrhosis: A systematic review and meta‐analysis

et al. 2022

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Objective This is the first systematic review and meta‐analysis of studies using any available functional method to examine differences in peripheral endothelial function between cirrhotic and non‐cirrhotic individuals. Methods Literature search involved PubMed, Web‐of‐Science, and Scopus databases, as well as gray literature sources. We included studies in adult subjects evaluating endothelial function with any semi‐invasive or non‐invasive functional method in patients with and without liver cirrhosis. Results From 3378 records initially retrieved, 15 studies with a total of 570 participants were included in the final quantitative meta‐analysis. In six studies examining endothelial function with flow‐mediated‐dilatation, no differences between patients with cirrhosis and controls were evident (WMD: 1.33, 95%CI [−2.87, 5.53], I2 = 97%, p < .00001). Among studies assessing differences in endothelial‐dependent or endothelial‐independent vasodilation with venous‐occlusion‐plethysmography, there were no significant differences between the two groups. When pooling all studies together, regardless of the technique used, no significant difference in endothelial function between cirrhotic patients and controls was observed(SMD: 0.79, 95%CI[−0.04, 1.63], I2 = 94%, p < .00001). Conclusions No differences in peripheral endothelial function assessed with semi‐invasive or non‐invasive functional methods exist between cirrhotic and non‐cirrhotic subjects. The increasing co‐existence of cardiovascular risk factors leading to impaired vascular reactivity in cirrhotic patients may partly explain these findings.

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Flow Mediated Dilation in Cirrhosis: A Pilot Study in Different Stages of the Disease

Cited by 3 publications

References 20 publications

Emerging concepts in the care of patients with cirrhosis and septic shock

Emerging concepts in the care of patients with cirrhosis and septic shock

Endothelial and microvascular function in liver cirrhosis: an old concept that needs re-evaluation?

Peripheral endothelial and microvascular damage in liver cirrhosis: A systematic review and meta‐analysis

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