The correction of autonomic dysfunction in cirrhosis by captopril

Dillon, John; Nolan, James; Thomas, H. W.; Williams, Brent C.; Neilson, J. M. M.; Bouchier, I. A. D.; Hayes, Peter

doi:10.1016/s0168-8278(97)80049-9

Cited by 37 publications

(22 citation statements)

References 13 publications

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“…Disparate events may contribute to the development of autonomic neuropathy and reduced HRV, including factors affecting nerve integrity, such as alterations in lipid metabolism, vitamin E deficiency, alcohol intake, immunologic mechanisms, and retention of toxic metabolites [11,13]. Moreover, vagal function may be inhibited by elevated angiotensin II production [21] and the sympathetic function may be impaired by blunted end-organ responsiveness [7,11] owing to either production of weak neurotransmitters [22] or a receptorial and postreceptorial defect [10,23]. In addition to these factors, vasodilating substances must be taken into account.…”

Section: Discussionmentioning

confidence: 99%

The Relationship of Heart Rate Variability with Severity and Prognosis of Cirrhosis

et al. 2006

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Many studies have demonstrated that cirrhosis is frequently associated with autonomic dysfunction. The aim of this study was to test autonomic dysfunction in cirrhotic patients by analyzing heart rate variability (HRV), to determine whether or not the degree of autonomic dysfunction is correlated with the severity of disease, and, also, to compare the changes of HRV between survivor and nonsurvivor groups after 2-year follow-up periods. HRV was analyzed using 24-hr ECG recording in 30 cirrhotic patients and 28 normal controls. The changes in HRV parameters including mean normal-to-normal (N-N) interbeat intervals (mean NN), standard deviation of all N-N intervals (SDNN), standard deviation of the average of N-N intervals for each 5-min period over 24 hr (SDANN), root mean square succesive differences (r-MSSD; msec), and percentage of adjacent N-N intervals that are >50 msec apart (pNN50), all as time domain parameters, were evaluated. The cirrhotic patients were also evaluated according to Child-Pugh classification scores as markers of the disease severity. The time-domain measures of HRV in cirrhotic patients were significantly reduced compared with those in the control group (for all parameters; P < 0.001). The severity of disease was associated with reduced HRV measures (for all parameters; P < 0.001). After the 2-year follow-up periods, HRV measurements in cirrhotic patients were significantly much lower in nonsurvivors than in survivors (P < 0.001 for all). We conclude that increasing severity of cirrhosis is associated with a reduction in HRV. This finding may be an indicator of poor prognosis and mortality for cirrhosis.

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Section: Discussionmentioning

confidence: 99%

The Relationship of Heart Rate Variability with Severity and Prognosis of Cirrhosis

et al. 2006

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“…2,16,18 Disparate events may contribute to the development of AD, including factors affecting nerve integrity, such as alterations in lipid metabolism, vitamin E deficiency, alcohol intake, immunologic mechanisms, and retention of toxic metabolites. 13,17 Moreover, vagal function may be inhibited by elevated angiotensin II production 37 and the sympathetic function may be impaired by a blunted end-organ responsiveness 9,12 owing to either a production of weak neurotransmitters 15 or a receptorial and postreceptorial defect. 12,38 In addition to these factors, vasodilating substances have to be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites

et al. 1999

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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. (HEPATOLOGY 1999;30:1387-1392.)Hyperdynamic circulation is a common and long-recognized feature of patients with advanced cirrhosis, 1 consisting of elevated cardiac rate and output and reduced peripheral vascular resistance, so that arterial pressure is tendentially or frankly reduced. The clinical importance of this disorder was shown by subsequent studies, showing that the alterations of systemic hemodynamics, renal function, and vasoactive systems are prognostic indicators even more accurate than the tests exploring liver function. 2 The setting of the hyperdynamic circulatory syndrome is the pathogenetic background of complications such as renal sodium and water retention and hepatorenal syndrome. 3 Splanchnic blood pooling, opening of portal-systemic collaterals, and arterial vasodilation, as well as a compensatory increase in blood volume, are the causative events of the hyperdynamic circulatory syndrome. 4,5 The pathogenesis of arterial vasodilation is still debated. It has been proposed that an overproduction of a variety of vasorelaxant agents, such as histamine, adenosine, gut-derived peptides and endothelial cell-derived vasodilators, and bile acid retention reduce the responsiveness of the vascular bed to endogenous vasoconstrictor stimuli. 4,6 The autonomic nervous system plays a central role in modulating cardiac performance and vasomotor activity. The presence of an autonomic dysfunction (AD) in cirrhosis has been clearly shown through different...

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“…Administration of an angiotensin converting enzyme inhibitor improves the HRV confirming that angiotensin II plays a role in AD. 9 In addition, administration of antioxidants seems to reverse blunted BP responses suggesting that oxidative stress may also play a role in AD. 10 AD is common in diabetic patients, and in those who suffer iatrogenic hypoglycemia there is a hypoglycemia-associated autonomic failure (HAAF).…”

Section: Pathogenesismentioning

confidence: 99%

Autonomic dysfunction in chronic liver disease

Frith

Newton

2009

Liver International

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Abstract:It is becoming increasingly clear that quality of life (QOL) is impaired in those with chronic liver disease (CLD). One of the most important contributors to impaired QOL is the symptomatic burden which can range from slight to debilitating. Autonomic dysfunction accounts for a significant proportion of these symptoms, which can be common, non-specific and challenging to treat. Investigating the autonomic nervous system can be straight forward and can assist the clinician to diagnose and treat specific symptoms. Evidence-based treatment options for autonomic symptoms, specifically in CLD, can be lacking and must be extrapolated from other studies and expert opinion. For those with severely impaired quality of life, liver transplantation may offer an improvement; however, more research is needed to confirm this.

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The correction of autonomic dysfunction in cirrhosis by captopril

Cited by 37 publications

References 13 publications

The Relationship of Heart Rate Variability with Severity and Prognosis of Cirrhosis

The Relationship of Heart Rate Variability with Severity and Prognosis of Cirrhosis

Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites

Autonomic dysfunction in chronic liver disease

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