Spontaneous baroreflex cardiac sensitivity in end-stage liver disease

Lhuillier, Franck; Dalmas, Élise; Gratadour, P; Cividjian, Andrei; Boillot, Olivier; Quintin, Luc; Viale, Jean–Paul

doi:10.1017/s0265021506000184

Cited by 15 publications

(13 citation statements)

References 41 publications

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“…Several studies have reported the presence of an autonomic neuropathy in cirrhosis, and most authors agree that the presence of autonomic dysfunction is related with the severity of liver disease, irrespective of its aetiology (15, 16, 18). A decrease in BRS in cirrhotic patients has been described both in experimental (13, 21, 22) and clinical studies (6, 23–26). In most human studies, the severity of cirrhosis was established according to clinical parameters and Child–Pugh score.…”

Section: Discussionmentioning

confidence: 96%

Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradient

Genovesi¹,

Pizzala²,

Pozzi³

et al. 2010

Liver International

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These data support the hypothesis that liver disease severity and particularly portal hypertension have an important role in the derangement of baroreceptor function. The aetiology of cirrhosis seems to be related to baroreceptor impairment as well. Mortality rate is higher in subjects with a more damaged autonomic system, strengthening the idea of a worse prognosis in cirrhotic patients with autonomic neuropathy.

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Section: Discussionmentioning

confidence: 96%

Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradient

Genovesi¹,

Pizzala²,

Pozzi³

et al. 2010

Liver International

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show abstract

“…Patients with end-stage liver disease are known to demonstrate abnormal cardiovascular autonomic function, especially decreased HRV and BRS, and inappropriate circulatory response to various stimuli [11,12,28,29]. Moller et al [11] suggested that head-up tilt can induce abnormalities in sympathetic control and vascular reactivity, which lead to hemodynamic instability in patients with liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

et al. 2013

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Objective Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS. Methods Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5 min of ECG and arterial blood pressure signals 10 min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence. Results Seventy-seven patients (35 %) developed PRS while 141 did not. There were significant differences in SBP (110 ± 16 vs. 119 ± 16 mmHg, P \ 0.001) and the ratio of low frequency power to high frequency power (LF/ HF) of HRV (1.0 ± 1.4 vs. 2.1 ± 3.7, P = 0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P = 0.028) and SBP (odds ratio 0.966, P \ 0.001).Interpretation Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.

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“…The majority (87%) of patients who undergo LT suffer from autonomic dysfunction. [ 22 ] Four years mortality is 30% in patients of ESLD with dysautonomia compared to 6% without dysautonomia. [ 23 ] The degree of dysautonomia usually improves after LT in up to 63% of patients within 6–7 months.…”

Section: Cardiomyopathymentioning

confidence: 99%

Preoperative cardiovascular investigations in liver transplant candidate: An update

et al. 2016

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Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation. Identifying candidates at the highest risk of postoperative cardiovascular complications is the cornerstone for optimizing the outcome. Ischaemic heart disease contributes to major portion of cardiovascular complications and therefore warrants evaluation in the preoperative period. Patients of ESLD usually demonstrate increased cardiac output, compromised ventricular response to stress, low systemic vascular resistance and occasionally bradycardia. Despite various recommendations for preoperative evaluation of cardiovascular disease in liver transplant candidates, a considerable controversy on screening methodology persists. This review critically focuses on the rapidly expanding body of evidence for diagnosis and risk stratification of cardiovascular disorder in liver transplant candidates.

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Spontaneous baroreflex cardiac sensitivity in end-stage liver disease

Abstract: These results confirm that the baroreflex sensitivity is depressed in end-stage liver disease in line with an autonomic nervous system imbalance. The liver transplantation reverses this disturbance only in some patients.

Cited by 15 publications

References 41 publications

Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradient

Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradient

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

Preoperative cardiovascular investigations in liver transplant candidate: An update

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