Increased flow‐mediated vasodilation in cirrhotic patients with ascites: relationship with renal resistive index

Abstract

These findings in vivo demonstrate that cirrhotic patients with ascites have an enhanced shear stress-induced peripheral vasodilation, which is closely related to intrarenal vasoconstriction.

Cardiovascular Risk Factors and Systemic Endothelial Function in Patients With Cirrhosis

“…However, these data are in agreement with previous studies showing an increased systemic vascular endothelial-dependent reactivity in cirrhosis, as assessed with other techniques ( 4 -7 ) and with the limited experience using FMD ( 17 ). Having said that, our data also demonstrate that about half of patients with cirrhosis show systemic endothelial dysfunction, which is particularly frequent among those with a greater number of CVRF and thereby with a higher 10-year cardiovascular risk, as assessed by the Framingham equation.…”

“…An increased FMD in this setting might represent another manifestation of this hemodynamic derangement. Th is interpretation would be in agreement with a previous study reporting that FMD increased in parallel with renal vasoconstriction ( 17 ), which represents the end of the spectrum of circulatory manifestations initiated by portal hypertension and splanchnic vasodilatation.…”

“…We could not reproduce the result obtained by Cazzaniga et al ( 17 ) showing that FMD was increased in patients with ascites vs. compensated patients. Th is might be due to diff erences in the profi le of cardiovascular risk of the patients included in the two studies, since only non-smokers and non-hypertensive patients were included in the published study ( 17 ); moreover, the abovementioned study included a large proportion of patients with very severe liver failure (Child C), with an extremely high FMD.…”

“…In non-cirrhotic subjects, CVRF impair FMD due to oxidative stress-induced systemic endothelial dysfunction ( 16 ). FMD has been used only in one study in patients with cirrhosis ( 17 ), showing that it is increased in patients with ascites.…”

Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis

“…The end result is a pooling of blood in the splanchnic vascular bed, akin to a splanchnic steal syndrome 15. The shunting of blood and excess vasodilators from the splanchnic to the systemic circulation following the opening of portal-systemic shunts related to increased portal pressure also leads to systemic arterial vasodilation 16. The combined effect causes a relative inadequacy of the systemic circulation, the so-called ‘reduction in the effective arterial blood volume’, thereby triggering a hyperdynamic circulation in these patients 17 18…”